The Icelandic study was published 10 years after the 2002 French study and, therefore, included new drugs, such as biological agents, that have a significant impact on the incidence of DILI. 5 This is a higher estimate than that of the French study, and several distinctions between the two studies are worth noting. In 2013, a study based on the Icelandic population revealed an incidence of DILI of 19.1 per 100,000 inhabitants per year. However, only 400 to 500 such cases were reported, suggesting that DILI was largely underestimated in the general population. When extrapolated to the country of France, this data predicted more than 8,000 cases of DILI annually. Data collected over 3 years revealed an annual incidence rate of drug induced liver injury (DILI) of 13.9 per 100,000 inhabitants. investigated a region in France where its inhabitants were likely to obtain their medical care locally, thus ensuring a truer estimate of incident liver injury. 3Īlthough there is still much to be learned about the epidemiology of drug and dietary supplement induced liver injury in the Western World, data from two population based studies published in France and Iceland provide some insight. Drug Induced Liver Injury Network (DILIN) has reported that the proportion of cases on liver injury attributed to HDS has increased over the past 10 years. However, direct causality is difficult to confirm, and the total impact of liver injury from HDS on the U.S. HDS usage is occasionally associated with liver injury, potentially leading to acute liver failure. Through this qualitative analysis, we aim to provide insight to the clinician who is faced with a patient with suspected liver injury from HDS and to the investigator who is focused on HDS research. The purpose of this review is to highlight the hepatotoxic potential of HDS weight loss products and to discuss the available case reports on liver injury due to such products. 2ĭirect causality to liver injury is difficult to establish with HDS, as they are comprised of a variety of different compounds that may change over time, are prone to contamination or adulteration, and can be used with other agents, including conventional medications. 1 More recent data from The National Health and Nutrition Examination Survey (NHANES) 2003-2006 have revealed a dramatic rise in usage, with approximately 50% of all Americans and 70% of adults ≥71 y reporting dietary supplement use. In the early 1970s, the prevalence of dietary supplement use was 28% and 38% among adult men and women, respectively. The use of herbal and dietary supplements (HDS) in the United States (U.S.) has steadily increased over the past several decades.
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