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

Elizabeth X. Zheng, Simona Rossi, Robert J. Fontana, Raj Vuppalanchi, Jay H. Hoofnagle, Ikhlas Khan and Victor J. Navarro ()
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Elizabeth X. Zheng: Einstein Medical Center
Simona Rossi: Einstein Medical Center
Robert J. Fontana: University of Michigan School of Medicine
Raj Vuppalanchi: Indiana University School of Medicine
Jay H. Hoofnagle: NIDDK, National Institutes of Health
Ikhlas Khan: University of Mississippi
Victor J. Navarro: Einstein Medical Center

Drug Safety, 2016, vol. 39, issue 8, No 5, 749-754

Abstract: 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.

Date: 2016
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DOI: 10.1007/s40264-016-0428-7

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