2012, Number 4
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Ann Hepatol 2012; 11 (4)
Hepatotoxicity associated with dietary energy supplements: use and abuse by young athletes
Avelar-Escobar G, Méndez-Navarro J, Ortiz-Olvera NX, Castellanos G, Ramos R, Gallardo-Cabrera VE, Vargas-Alemán JJ, Díaz LÓ, Rodríguez EV, Dehesa-Violante M
Language: English
References: 26
Page: 564-569
PDF size: 259.21 Kb.
ABSTRACT
In recent years there has been a significant increase in the consumption of dietary energy supplements
(DES) associated with the parallel advertising against obesity and favoring high physical performance. We
present the case and outcome of a young patient who developed acute mixed liver injury (hepatocellular
and cholestatic) after ingestion of various “over the counter” products to increase muscle mass and physical
performance (NO Xplode
®, creatine, L-carnitine, and Growth Factor ATN
®). The diagnosis was based
on the exclusion of other diseases and liver biopsy findings. The dietary supplement and herbal multivitamins
industry is one with the highest growth rates in the market, with annual revenues amounting to billions
and constantly lacking scientific or reproducible evidence about the efficacy and/or safety of the offered
products. Furthermore, and contrary to popular belief, different forms of injury associated with these
natural substances have been documented particularly in the liver, supporting the need of a more strict
regulation.
REFERENCES
Stickel F, Kessebohm K, Weiman R, Seitz K. Review of liver injury associated with dietary supplements. Liver Int 2011; 31(5): 595-605.
DesJardins M. Supplement use in the adolescent athlete. Current Sports Medicine Reports 2002; 1: 369-73.
Favreau JT, Ryu ML, Braunstein G, et al. Severe hepatotoxicity associated with dietary supplement LipoKinetix. Ann Intern Med 2002; 136: 590-5.
Di Luigi L. Supplements and the endocrine system in athletes. Clin Sports Med 2008; 27: 131-51.
Hardy ML. Dietary supplement use in cancer care: Help or Harm. Hematol Oncol Clin N Am 2008; 22: 581-617.
Stickel F, Droz S, Patsenker E, Bögli-Stuber K, Aebi B, Leib SL. Severe hepatotoxicity following ingestion of Herbalife nutritional supplements contaminated with Bacillus subtilis. J Hepatol 2009; 50: 111-7.
García-Cortes M, Borraz Y, Lucena MI, et al. Liver injury induced by “natural remedies”: an analysis of cases submitted to the Spanish Liver Toxicity Registry. Rev Esp Enferm Dig 2008; 100: 688-95.
Schoepfer AM, Engel A, Fattinger K, et al. Herbal does not mean innocuous: Ten cases of severe hepatotoxicity associated with dietary supplements from Herbalife products. J Hepatology 2007; 47: 521-6.
Fong TL, Klontz K, Canas-Coto A, et al. Hepatotoxicity due to hydroxycut: A case series. Am J Gastroenterol 2010; 105: 1561-6.
Sanchez W, Maple JT, Burgart LJ, Kamath PS. Severe hepatotoxicity associated with use of a dietary supplement containing usnic acid. Mayo Clin Proc 2006; 81: 541-4.
Shah N, Zacharias I, Khettry U, Addhal N. Methasteron- Associatd Cholestatic Liver Injury: Clinicopathologic Findings in 5 cases. Clin Gastroenterol Hepatol 2008; 6: 255-8.
Pugh AJ, Barve AJ, Falkener K, Patel M, McClain CJ. Drug- Induced hepatotoxicity or drug-induced liver injury. Clin Liver Dis 2009; 13: 277-94.
Teschke R, Schwarzenboeck A, Hennermann KH. Causality assessment in hepatotoxicity by drugs and dietary supplements. Br J Clin Pharmacol 2008; 66: 758-66.
Teschke R. Hepatotoxicity by drugs and dietary supplements: safety perspectives on clinical and regulatory issues. Ann Hepatol 2009; 8: 184-95.
Scheuer PJ, Lefkowitch JH. Drugs and toxins. In: Liver Biopsy Intrepetation. 7th Ed. London UK: Elsevier & Saunders; 2006, p. 134-48.
Zimmerman HJ, Ishak KG. Hepatic injury due to drugs and toxins. In: MacSween RNM, Burt AD, Portmann BC (eds.). Pathology of the liver. 4th Ed. Edinburg: Churchill Livingstone; 2002, p. 621.
Aithal GP, Rawlins MD, Day CP. Clinical diagnostic scale: a useful tool in the evaluation of suspected hepatotoxic adverse drug reactions. J Hepatol 2000; 33: 949-52.
Sleeper RB, Kennedy SM. Adverse reaction to a dietary supplement in an elderly patient. Ann Pharmacother 2003; 37: 83-6.
Magee CD, Moawad FJ, Moses F. NO-Xplode: a case of supplement-associated ischemic colitis. Mil Med 2010; 175: 202-5.
Prosser JM, Majlesi N, Chan GM, Olsen D, Hoffman RS, Nelson LS. Adverse effects associated with arginine a-ketoglutarate containing supplements. Hum Exp Toxicol 2009; 28: 259-62.
Wang JS, Tan N, Dhawan A. Significance of low or normal serum gamma glutamyl transferase level in infants with idiopathic neonatal hepatitis. Eur J Pediatr 2006; 165: 795-801.
Davit-Spraul A, Fabre M, Branchereau S, et al. ATP8B1 and ABCB11 analysis in 62 children with normal Gammaglutamyl transferase progressive Familial intrahepatic cholestasis (PFIC): Phenotypic differences between PFIC1 and PFIC2 and natural history. Hepatology 2010; 51: 1645-55.
Diario Oficial de la Federación (DOF). Norma Oficial Mexicana NOM-251-SSA1-2009. Prácticas de higiene para el proceso de alimentos, bebidas o suplementos alimenticios. 1 de marzo de 2010. Disponible en: http:// www.dof.gob.mx/documentos/3980/salud/salud.htm [Retrieved: October 2011].
Comisión Federal para la protección contra riesgos sanitarios (COFEPRIS). Productos milagro, su regulación comercial y publicitaria en México. Disponible en: http:// www.cofepris.gob.mx/work/sites/cfp/resources/Local- Content/402/1/b55.pdf [Retrieved: June 11, 2011].
Cofepris ordena retiros de más de 250 productos “Milagro” por publicidad engañosa. 14 de febrero 2011. Disponible en: http://www.cofepris.gob.mx/Notas%20Principales/ 2011/Documentos/PM.pdf [Retrieved: June 11, 2011].
Alerta Cofepris sobre el crecimiento de suplementos alimenticios para bajar supuestamente de peso. 26 de Agosto 2009. Disponible en: http://mymanuel.wordpress.com/ 2009/08/30/mexico-alerta-cofepris-sobre-el-crecimientode- suplementos-alimenticios-para-bajar-supuestamentede- peso/ [Retrieved: June 11, 2011].