The DOI matches its Crossref record; 1 of the 1 references it cites were found in a registry or an index.
The Contents of Herbal and Dietary Supplements Implicated in Liver Injury in the United States Are Frequently Mislabeled
Open accessAbstract
The U.S. Drug Induced Liver Injury Network assayed the contents of herbal and dietary supplements collected from patients enrolled into its prospective study. The aim was to determine the accuracy of product labels, and to identify known hepatotoxins. Using high‐performance liquid chromatography coupled with mass spectrometry to assay 272 product, 51% were found to be mislabeled; that is, to have chemical contents that did not match the label. Appearance enhancement, sexual performance, and weight loss products were most commonly mislabeled. Whether the mislabeling contributed to liver injury is under study; however, the high mislabeling rate underscores the need for more stringent regulation of supplements.
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Mild elevations of autoimmune markers are very commonly described in patients with DILI.
“and are very commonly described in patients with DILI”
From Ashwagandha-induced liver injury—A case series from India and literature review (2023) · cites this paper as [31]
The Materials and Methods and Results discuss DILI cases and supplement-label testing, but do not report autoimmune-marker levels or how commonly they occur. Searches for autoimmune markers, autoantibodies, ANA, and related serology found no passage addressing the claim. (LLM, conf=0.76)
Experimental — accuracy not yet measuredMild elevations of autoimmune markers are not pathognomonic for autoimmune hepatitis.
“Mild elevations of autoimmune markers are not pathognomonic for autoimmune hepatitis”
From Ashwagandha-induced liver injury—A case series from India and literature review (2023) · cites this paper as [31]
The Materials and Methods and Discussion passages address supplement contents, mislabeling, and liver injury, not the diagnostic significance of autoimmune markers. Searches for autoimmune markers, autoantibodies, and autoimmune hepatitis found no passage in our copy addressing the claim; page numbers were not available. (LLM, conf=0.76)
Experimental — accuracy not yet measuredDrug-triggered autoimmune hepatitis is not uncommon, especially in the context of HILI.
“and drug-triggered autoimmune hepatitis is not uncommon, especially in the context of HILI.7,9,17,31”
From Ashwagandha-induced liver injury—A case series from India and literature review (2023) · cites this paper as [31]
The Materials and Methods and Discussion (pages unavailable) address liver injury associated with herbal and dietary supplements and the accuracy of supplement labels, but do not address autoimmune hepatitis or how commonly it is drug-triggered in HILI. Searches for “autoimmune hepatitis” and “drug-triggered autoimmune hepatitis in herbal-induced liver injury” found no passage supporting that point. (LLM, conf=0.74)
Experimental — accuracy not yet measuredLiver-specific causality scales do not capture the complexity of HDS-induced liver injury and are therefore not suitable for attributing causality in that context, because HDS products are frequently multi-ingredient and the toxic compound is often not identified or mislabelled.
“However, it is important to emphasize that the liver‐specific scales do not capture the complexity of HDS‐induced liver injury and are therefore not suitable for attributing causality in this context, as these products are frequently multi‐ingredient and the toxic compound is often not identified or mislabelled.”
From Methods for causality assessment of idiosyncratic drug‐induced liver injury (2025) · cites this paper as [52]
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Citations
Cites
Liver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network
Navarro, V. J., Barnhart, H., Bonkovsky, H. L., Davern, T., Fontana, R. J., Grant, L., Reddy, R. K., Seeff, L. B., Serrano, J., Sherker, A. H., et al. (2014) · Hepatology · doi:10.1002/hep.27317 · Cited by 418
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Flagged first, then by citations
Research works printed but not linked: 2
- 2016, Trends in dietary supplement use among US adults from 1999‐2012, JAMA, 316, 1464, 10.1001/jama.2016.14403 · DOI · Paper page
- 2014, Sales of dietary supplements increase by 7.9% in 2013, HerbalGram, 103, 52
Cited by
Sorted by citations
AASLD practice guidance on drug, herbal, and dietary supplement–induced liver injury
Fontana, R. J., Liou, I., Reuben, A., Suzuki, A., Fiel, M. I., Lee, W., & Navarro, V. (2023) · Hepatology · doi:10.1002/hep.32689 · Cited by 340
Self-citationAshwagandha-induced liver injury—A case series from India and literature review
Philips, C. A., Valsan, A., Theruvath, A. H., Ravindran, R., Oommen, T. T., Rajesh, S., Bishnu, S., Augustine, P., & India, O. B. O. T. L. R. C. (2023) · Hepatology Communications · doi:10.1097/hc9.0000000000000270 · Cited by 62
Methods for causality assessment of idiosyncratic drug‐induced liver injury
García‐Cortés, M., Matilla‐Cabello, G., & Lucena, M. I. (2025) · Liver International · doi:10.1111/liv.16083 · Cited by 15
Metadata
- Authors
- Navarro, V., Avula, B., Khan, I., Verma, M., Seeff, L., Serrano, J., Stolz, A., Fontana, R., & Ahmad, J.
- Affiliations
- Einstein Healthcare Network (US)
- University of Mississippi (US)
- Liver Diseases Branch,National Institute of Diabetes and Digestive and Kidney Diseases,Bethesda,MD
- University of Southern California (US)
- University of Michigan (US)
- Icahn School of Medicine at Mount Sinai (US)
- Corresponding author
- Navarro, Victor
- ORCID
- Venue
- Hepatology Communications
- Published
- 2019-04-03
- Volume
- 3
- Issue
- 6
- Pages
- 792-794
- ISSN
- 2471-254X (ISSN-L)
- PMC
- PMC6545864
- OpenAlex
- W2926569512
- Cited by
- 52
- References
- 1
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 13 · 2023: 7 · 2022: 7 · 2021: 5 · 2020: 7 · 2019: 3
- FWCI
- 5.04
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Hepatology Communications (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Bristol-Myers Squibb
- Gilead Sciences
- National Institutes of Health (5u01dk065211-22, 5u01dk065184-22)
- National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK-065184, U24DK065176, U01 DK-065211, U01DK100928, UO1 DK083027, U01DK083027, U01DK065201, U01DK083020)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pharmaceutical Quality and Counterfeiting
- Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Drug-Induced Hepatotoxicity and Protection
- Keywords
- herbal supplements, dietary supplements, mislabeling, drug-induced liver injury, hepatotoxicity, supplement regulation, weight loss products
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