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Cited by 30

The DOI matches its Crossref record; 45 of the 45 references it cites were found in a registry or an index.

Estimated Exposure to 6 Potentially Hepatotoxic Botanicals in US Adults

Likhitsup, Alisa, Chen, Vincent L., Fontana, Robert J.·2024·JAMA Network Open
DOI 10.1001/jamanetworkopen.2024.25822PMC PMC11301549
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Abstract

Importance: Use of herbal and dietary supplements (HDSs) accounts for an increasing proportion of drug hepatotoxicity cases. Turmeric or curcumin, green tea extract, Garcinia cambogia, black cohosh, red yeast rice, and ashwagandha are the most frequently reported hepatoxic botanicals, but their prevalence and reasons for use in the general population are unknown. Objective: To assess the prevalence and clinical characteristics of adult consumers of 6 potentially hepatoxic botanicals. Design, Setting, and Participants: This survey study analyzed nationally representative data from the National Health and Nutrition Examination Survey (NHANES), a nationally representative, cross-sectional survey of the general US population. Prescription drug and HDS exposure data in the past 30 days were analyzed, and 2020 US Census data were used for population estimates. Data were analyzed July 1, 2023, to February 1, 2024. Exposures: Adult NHANES participants enrolled between January 2017 and March 2020. Main Outcomes and Measures: Baseline weighted characteristics of HDS users and users of 6 potentially hepatotoxic botanical products were compared with non–HDS users. Multivariable analysis was undertaken to identify factors associated with HDS use or at-risk botanical use. Results: Among 9685 adults enrolled in this NHANES cohort, the mean (SE) age was 47.5 (0.5) years, and 51.8% (95% CI, 50.2%-53.4%) were female. The overall prevalence of HDS product use was 57.6% (95% CI, 55.9%-59.4%), while the prevalence of using the 6 botanicals of interest was 4.7% (95% CI, 3.9%-5.7%). Turmeric-containing botanicals were most commonly used (n = 236), followed by products containing green tea (n = 92), ashwagandha (n = 28), Garcinia cambogia (n = 20), red yeast rice (n = 20), and black cohosh (n = 19). Consumers of these 6 botanicals were significantly older (adjusted odds ratio [AOR], 2.36 [95% CI, 1.06-5.25]; P = .04 for 40-59 years of age and AOR, 3.96 [95% CI, 1.93-8.11]; P = .001 for ≥60 years of age), had a higher educational level (AOR, 4.78 [95% CI, 2.62-8.75]; P < .001), and were more likely to have arthritis (AOR, 2.27 [95% CI, 1.62-3.29]; P < .001) compared with non–HDS users. An estimated 15 584 599 (95% CI, 13 047 571-18 648 801) US adults used at least 1 of the 6 botanical products within the past 30 days, which was similar to the estimated number of patients prescribed potentially hepatotoxic drugs, including simvastatin (14 036 024 [95% CI, 11 202 460-17 594 452]) and nonsteroidal anti-inflammatory drugs (14 793 837 [95% CI, 13 014 623-16 671 897]). The most common reason for consuming turmeric and green tea was to improve or maintain health. Conclusions and Relevance: In this survey study, an estimated 15.6 million US adults consumed at least 1 botanical product with liver liability within the past 30 days, comparable with the number of people who consumed nonsteroidal anti-inflammatory drugs and a commonly prescribed hypolipidemic drug. Given a lack of regulatory oversight on the manufacturing and testing of botanical products, clinicians should be aware of possible adverse events from consumption of these largely unregulated products.

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Figures

Figure 1. Self-Reported Reasons for Consuming 6 Potentially Hepatotoxic Botanical Products
Figure 1. Self-Reported Reasons for Consuming 6 Potentially Hepatotoxic Botanical ProductsCC BY · PubMed Central
Figure 2. United States Population Estimates for Use of 6 Potentially Hepatotoxic Botanical Products Compared With 3 Commonly Prescribed Medications Data are based on 2020 US Census estimated total resident population 18 years of age or older of 329 484 123 July 1, 2020.21 Whiskers represent 95% CI. NSAIDs indicates nonsteroidal anti-inflammatory drugs.
Figure 2. United States Population Estimates for Use of 6 Potentially Hepatotoxic Botanical Products Compared With 3 Commonly Prescribed Medications Data are based on 2020 US Census estimated total resident population 18 years of age or older of 329 484 123 July 1, 2020.21 Whiskers represent 95% CI. NSAIDs indicates nonsteroidal anti-inflammatory drugs.CC BY · PubMed Central

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Cites

Research works printed but not linked: 4

  1. Zipf, 2013, Vital Health Stat 1
  2. US Food and Drug Administration, 1994, Dietary Supplement Health and Education Act of 1994; Public Law 103–417
  3. American Medical Association. Dietary supplements: underregulated, unknown, and maybe unsafe. Accessed January 19, 2024. https://www.ama-assn.org/delivering-care/public-health/dietary-supplements-underregulated-unknown-and-maybe-unsafe
  4. National Institute of Diabetes and Digestive and Kidney Diseases. LiverTox: clinical and research information on drug-induced liver injury, 2012-. Updated June 20, 2024. Accessed January 19, 2024. https://www.ncbi.nlm.nih.gov/books/NBK547852/

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Metadata

Authors
Likhitsup, A., Chen, V. L., & Fontana, R. J.
Affiliations
Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2024-08-05
Volume
7
Issue
8
Pages
e2425822
ISSN
2574-3805
DOI
10.1001/jamanetworkopen.2024.25822
PMC
PMC11301549
Cited by
30
References
45
Language
en

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