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Risk of Liver Injury Associated with Green Tea Extract in SLIMQUICK® Weight Loss Products: Results from the DILIN Prospective Study

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Abstract

Introduction

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.

Methods

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.

Results

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/m2). 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.

Conclusions

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.

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Authors and Affiliations

  1. Einstein Medical Center, 5401 Old York Road, Philadelphia, PA, 19141, USA

    Elizabeth X. Zheng, Simona Rossi & Victor J. Navarro

  2. University of Michigan School of Medicine, Ann Arbor, MI, USA

    Robert J. Fontana

  3. Indiana University School of Medicine, Indianapolis, IN, USA

    Raj Vuppalanchi

  4. NIDDK, National Institutes of Health, Bethesda, MD, USA

    Jay H. Hoofnagle

  5. University of Mississippi, Oxford, MS, USA

    Ikhlas Khan

Authors
  1. Elizabeth X. Zheng
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  2. Simona Rossi
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  3. Robert J. Fontana
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  4. Raj Vuppalanchi
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  5. Jay H. Hoofnagle
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  6. Ikhlas Khan
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  7. Victor J. Navarro
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Corresponding author

Correspondence to Victor J. Navarro.

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Conflict of interest

Elizabeth Zheng, Simona Rossi, Robert Fontana, Raj Vuppalanchi, Jay Hoofnagle, Iklhas Khan and Victor Navarro have no conflicts of interest that are directly relevant to the content of this study.

Financial support

The Drug-Induced Liver Injury Network (DILIN) is structured as a U01 cooperative agreement supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institute of Health (NIH) with funds provided by the following Grants: U01DK065211 (Indiana University [Purdue]), U01DK065184 (University of Michigan [Ann Arbor]), U01DK065201 (University of North Carolina [Chapel Hill], Asheville, Wake Forest Baptist Medical Center), U01DK083020 (University of Southern California, University of California–Los Angeles [Pfleger Liver Institute]), U01DK083027 (Albert Einstein Medical Center), U01DK100928 (Icahn School of Medicine at Mount Sinai), U01DK065176 (Duke Clinical Research Institute). Additional support was provided by the Intramural Division of the National Cancer Institute (NCI), NIH.

Additional information

For the Drug-Induced Liver Injury Network (DILIN).

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Zheng, E.X., Rossi, S., Fontana, R.J. et al. Risk of Liver Injury Associated with Green Tea Extract in SLIMQUICK® Weight Loss Products: Results from the DILIN Prospective Study. Drug Saf 39, 749–754 (2016). https://doi.org/10.1007/s40264-016-0428-7

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  • DOI: https://doi.org/10.1007/s40264-016-0428-7

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