Skip to main content

Advertisement

Springer Nature Link
Log in

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

  • Original Research Article
  • Published:
Drug Safety Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Explore related subjects

Discover the latest articles and news from researchers in related subjects, suggested using machine learning.

References

  1. Navarro VJ, Barnhart H, Bonkovsky HL, et al. Liver injury from herbals and dietary supplements in the US drug induced liver injury network. Hepatology. 2014;60(4):1399–408.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bailey RL, Gahche JJ, Lentino CV, et al. Dietary supplement use in the United States, 2003–2006. J Nutr. 2011;141:261–6.

    Article  CAS  PubMed  Google Scholar 

  3. Fong TL, Klontz KC, Canas-Coto A, et al. Hepatotoxicity due to hydroxycut: a case series. Am J Gastroenterol. 2009;105:1561–6.

    Article  Google Scholar 

  4. Roytman MM, Pörzgen P, Lee CL, Huddleston L, Kuo TT, et al. Outbreak of severe hepatitis linked to weight-loss supplement OxyELITE Pro. Am J Gastroenterol. 2014;109:1296–8.

    Article  PubMed  Google Scholar 

  5. Zheng EX, Navarro VJ. Liver injury from herbal, dietary, and weight loss supplements: a review. J Clin Transl Hepatol. 2015;3(2):93–8.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Fontana RJ, Watkins PB, Bonkovsky HL, DILIN Study Group, et al. Drug-Induced Liver Injury Network (DILIN) prospective study: rationale, design, and conduct. Drug Saf. 2009;32(1):55–68.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Chalasani N, Bonkovsky HL, Fontana R, United States Drug Induced Liver Injury Network, et al. Features and outcomes of 899 patients with drug-induced liver injury: the DILIN prospective study. Gastroenterol. 2015;148:1340–52.

  8. SLIMQUICK® Official Site - Weight Loss For Women. SLIMQUICK® Official Site. N.p., 2016. Web 3 Apr. 2016. http://www.myslimquick.com/. Accessed 3 Apr 2016.

  9. Moon HS, Lee HG, Choi YJ, et al. Proposed mechanisms of epigallocatechin-3-gallate for anti-obesity. Chem Biol Interact. 2007;167(2):85–98.

    Article  CAS  PubMed  Google Scholar 

  10. Galati G, Alison Lin, Sultan A, et al. Cellular and in vivo hepatotoxicity caused by green tea phenolic acids and catechins. Free Radical Bio Med. 2006;40(4):570–80.

    Article  CAS  Google Scholar 

  11. Bonkovsky HL. Hepatotoxicity associated with supplements containing Chinese green tea (Camellia sinesis). Ann Intern Med. 2006;144(1):68–9.

    Article  PubMed  Google Scholar 

  12. Mazzanti G, Menniti-Ippolito F, Moro PA, et al. Hepatotoxicity from green tea: a review of the literature and two unpublished cases. Eur J Clin Pharmacol. 2009;65:331–41.

    Article  PubMed  Google Scholar 

  13. Navarro VJ, Bonkovsky HL, Hwang S, Vega M, Barnhart H, Serrano J. Catechins in dietary supplements and hepatotoxicity. Dig Dis Sci. 2013;58(9):2682–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Rockey DC, Seeff LB, Rochon J, Freston J, Chalasani N, Bonacini M, et al. Causality assessment in drug-induced liver injury using a structured expert opinion process: comparison to the Roussel-Uclaf causality assessment method. Hepatology. 2010;51:2117–26.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Teschke R, Genthner A, Wolff A, Frenzel C, Schulze J, Eickhoff A. Herbal hepatotoxicity: analysis of cases with initially reported positive re-exposure tests. Dig Liver Dis. 2014;46:264–9.

    Article  PubMed  Google Scholar 

  16. Wolfram S, Wang Y, Thielecke F. Anti-obesity effects of green tea: from bedside to bench. Mol Nutr Food Res. 2006;50:176–87.

    Article  CAS  PubMed  Google Scholar 

  17. Mao-Jung L, Maliakal P, Chen L, et al. Pharmacokinetics of tea catechins after ingestion of green tea and (-)-Epigallocatechin-3-gallate by humans. Cancer Epidemiol Biomark Prev. 2002;11:1025–32.

    Google Scholar 

  18. Chen IJ, Liu CY, Chiu JP, et al. Therapeutic effect of high-dose green tea extract on weight reduction: A randomized, double-blind, placebo-controlled clinical trial. Clin Nutr. 2015. doi:10.1016/j.clnu.2015.05.003 (Epub ahead of print).

  19. Lambert JD, Kennett MJ, Sang S, et al. Hepatotoxicity of high oral dose (-)-epigallocatechin-3-gallate in mice. Food Chem Toxicol. 2010;48(1):409–16.

    Article  CAS  PubMed  Google Scholar 

  20. Search Livertox Database. Livertox.nih.gov. N.p., 2016. Web. 1 May 2016. http://livertox.nih.gov/. Accessed 9 Jan 2016.

  21. Weinstein DH, Twaddell WS, Raufman JP, et al. SlimQuick associated hepatotoxicity in a woman with alpha-1 antitrypsin heterozygosity. World J Hepatol. 2012;4(4):154–7.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Whitsett M, De Marzio DH, Rossi S. SlimQuick associated hepatotoxicity resulting in fulminant liver failure and orthotopic liver transplantation. ACG Case Rep J. 2014;1(4):220–2.

    PubMed  PubMed Central  Google Scholar 

  23. Kapetanovic IM, Crowell JA, Krishnaraj R, et al. Exposure and toxicity of green tea polyphenols in fasted and non-fasted dogs. Toxicology. 2009;260:28–36.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

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
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Simona Rossi
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Robert J. Fontana
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Raj Vuppalanchi
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Jay H. Hoofnagle
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Ikhlas Khan
    View author publications

    You can also search for this author inPubMed Google Scholar

  7. Victor J. Navarro
    View author publications

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to Victor J. Navarro.

Ethics declarations

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).

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 96 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Published:

  • Issue Date:

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

Keywords