title: Risk of Liver Injury Associated with Green Tea Extract in SLIMQUICK(®) Weight Loss Products: Results from the DILIN Prospective Study.
abstract: Herbal and dietary supplements (HDS) have been increasingly recognized as a cause for acute liver injury (Navarro et al. Hepatology 60(4):1399-1408, 2014; Bailey et al. J Nutr 141:261-266, 2011). HDS products frequently contain numerous ingredients, and are marketed under various product names. A perusal of marketed weight loss products indicates that green tea extract (GTE) is a common ingredient in many. We aimed to describe the course and outcome of six patients who developed liver injury attributed to SLIMQUICK(®) weight loss products.
  
  
  
  Patients with suspected drug-induced liver injury were enrolled in a prospective study of the Drug-Induced Liver Injury Network (DILIN) and causality was assessed by a panel of hepatologists. During the period under study, 6 of 1091 cases of liver injury were attributed to a SLIMQUICK(®) product and were assigned causality scores of probable, highly likely, or definite.
  
  
  
  Six cases of acute liver injury attributed to SLIMQUICK(®) products were enrolled in the DILIN prospective study between 2007 and 2011. All were women aged 22 to 58 years. Two had a normal body weight and four were mildly obese (body mass index 22.9-32.2 kg/m(2)). All were taking SLIMQUICK(®) products for weight loss and no patient reported prior use. Laboratory tests revealed a hepatocellular pattern of injury, with initial alanine aminotransferase (ALT) levels above 1000 U/L in all but one patient. Three patients were hospitalized and one underwent successful liver transplantation. No patients died of liver injury. GTE and/or its component catechins were listed among the ingredients for five of the six products.
  
  
  
  SLIMQUICK(®) products can lead to severe acute hepatocellular liver injury, which may result in transplantation. Given the frequency of GTE as a component in weight loss products, this ingredient should be studied further as a possible cause for liver injury.
authors.affiliation: Einstein Medical Center, 5401 Old York Road, Philadelphia, PA, 19141, USA.
authors.forename: Elizabeth X
authors.initials: EX
authors.lastname: Zheng
authors.affiliation: Einstein Medical Center, 5401 Old York Road, Philadelphia, PA, 19141, USA.
authors.forename: Simona
authors.initials: S
authors.lastname: Rossi
authors.affiliation: University of Michigan School of Medicine, Ann Arbor, MI, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Fontana
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Raj
authors.initials: R
authors.lastname: Vuppalanchi
authors.affiliation: NIDDK, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Jay H
authors.initials: JH
authors.lastname: Hoofnagle
authors.affiliation: University of Mississippi, Oxford, MS, USA.
authors.forename: Ikhlas
authors.initials: I
authors.lastname: Khan
authors.affiliation: Einstein Medical Center, 5401 Old York Road, Philadelphia, PA, 19141, USA. navarrov@einstein.edu.
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Navarro
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000378:metabolism; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000209:etiology*; D019587:Dietary Supplements / Q000009:adverse effects*; D005260:Female; D006760:Hospitalization; D006801:Humans; D016031:Liver Transplantation; D008875:Middle Aged; D010936:Plant Extracts / Q000008:administration & dosage / Q000009:adverse effects*; D011446:Prospective Studies; D012720:Severity of Illness Index; D013662:Tea / Q000737:chemistry*; D015431:Weight Loss; D055815:Young Adult
chemical_list: D010936:Plant Extracts; D013662:Tea; D000410:Alanine Transaminase