Patients with liver injury attributed to ingesting nonbodybuilding herbal and dietary supplements had greater mortality and liver transplantation rates compared with patients taking bodybuilding supplements, according to new study data.
Patients with hepatoxicity were recruited from eight referral centers in the Drug-Induced Liver Injury Network (DILIN) to evaluate liver injury due to herbal and dietary supplements (HDS). Among 839 patients enrolled, 709 had injury caused by medications, 45 by bodybuilding HDS and 85 by nonbodybuilding HDS. All bodybuilding HDS cases occurred among young men, while nonbodybuilding HDS cases were more frequent in middle-aged women.
During the study (2004-2013), liver injury caused by HDS increased from 7% to 20% (P<.001), and was attributed to bodybuilding HDS cases growing from 2% in 2004-2005 to 8% in 2010-2012 (P=.007). During the same period, nonbodybuilding HDS incidence of liver injury grew from 5% to 12% (P=.05).
Bodybuilding HDS caused prolonged jaundice, but did not lead to mortality or liver transplant. Nonbodybuilding HDS cases had an increased rate for both death and transplantation compared with cases of injury from medications (13% vs. 3%; P<.05). Thirteen nonbodybuilding HDS patients died or underwent transplantation. Overall, the HDS liver injury group had a greater number of severe cases based on DILIN severity score compared with the group with liver injury due to medications (P=.02).
“The proportion of liver injury cases attributed to HDS in DILIN has increased significantly,” the researchers wrote. “Liver injury from nonbodybuilding HDS is more severe than from bodybuilding HDS or medications, as evidenced by differences in unfavorable outcomes (death and transplantation).”
Disclosure: See the study for a full list of relevant financial disclosures.