title: Moderate doses of commercial preparations of Ginkgo biloba do not alter markers of liver function but moderate alcohol intake does: A new approach to identify and quantify biomarkers of 'adverse effects' of dietary supplements.
abstract: It is difficult to determine if certain dietary supplements are safe for human consumption. Extracts of leaves of Ginkgo biloba trees are dietary supplements used for various purported therapeutic benefits. However, recent studies reported they increased risk of liver cancer in rodents. Therefore, this study assessed the association between ginkgo consumption and liver function using NHANES 2001-2012 data (N = 29,684). Since alcohol is known to adversely affect liver function, association of its consumption with liver function was also assessed. Alcohol and ginkgo extract intake of adult consumers and clinical markers of liver function (alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, gamma glutamyl transferase, lactate dehydrogenase, bilirubin) were examined. Moderate consumers of alcohol (0.80 ± 0.02 drinks/day) had higher levels of aspartate aminotransferase and gamma glutamyl transferase than non-consumers (P < 0.001). There was no difference (P > 0.01) in levels of markers of liver function in 616 ginkgo consumers (65.1 ± 4.4 mg/day intake) compared to non-consumers. While moderate alcohol consumption was associated with changes in markers of liver function, ginkgo intake as typically consumed by U.S. adults was not associated with these markers. Biomarkers measured by NHANES may be useful to examine potential adverse effects of dietary supplements for which insufficient human adverse event and toxicity data are available.
  
  
  BACKGROUND
  Not applicable, as this is secondary analysis of publicly released observational data (NHANES 2001-2012).
authors.affiliation: Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA 01760, USA. Electronic address: harris.r.lieberman.civ@mail.mil.
authors.forename: Harris R
authors.initials: HR
authors.lastname: Lieberman
authors.affiliation: Department of Laboratory Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA. Electronic address: mark.kellogg@childrens.harvard.edu.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Kellogg
authors.affiliation: Oak Ridge Institute for Science and Education, Belcamp, MD 21017, USA; Henry M. Jackson Foundation, Bethesda, MD 20817, USA. Electronic address: vic3rd@aol.com.
authors.forename: Victor L
authors.initials: VL
authors.lastname: Fulgoni
authors.affiliation: Oak Ridge Institute for Science and Education, Belcamp, MD 21017, USA. Electronic address: agarwal47@yahoo.com.
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Agarwal
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D004796:Clinical Enzyme Tests; D003257:Consumer Product Safety; D003430:Cross-Sectional Studies; D019587:Dietary Supplements / Q000009:adverse effects*; D005260:Female; D020441:Ginkgo biloba / Q000009:adverse effects* / Q000737:chemistry; D006801:Humans; D008099:Liver / Q000187:drug effects* / Q000201:enzymology; D008108:Liver Diseases, Alcoholic / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D008517:Phytotherapy; D010936:Plant Extracts / Q000009:adverse effects* / Q000302:isolation & purification; D018515:Plant Leaves; D010946:Plants, Medicinal; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D000096983:Ginkgo Extract
chemical_list: D010936:Plant Extracts; C063170:Ginkgo biloba extract; D000096983:Ginkgo Extract
keywords: Alanine aminotransferase; Aspartate aminotransferase; Bilirubin; Gamma glutamyl transferase; Lactate dehydrogenase; NHANES