■使用草药和膳食补充剂(HDS)占药物肝毒性病例的比例越来越高。姜黄或姜黄素,绿茶提取物,藤黄果,黑升麻,红曲米,和ashwagandha是最常见的肝毒性植物药,但它们在普通人群中的患病率和使用原因尚不清楚。
■评估6种潜在肝毒性植物药的成年消费者的患病率和临床特征。
■这项调查研究分析了国家健康与营养调查(NHANES)的全国代表性数据,全国代表,美国总人口的横断面调查。分析了过去30天的处方药和HDS暴露数据,2020年美国人口普查数据用于人口估计。数据进行了2023年7月1日至2024年2月1日的分析。
■成人NHANES参与者在2017年1月至2020年3月之间注册。
■将HDS使用者和6种潜在肝毒性植物产品使用者的基线加权特征与非HDS使用者进行了比较。进行多变量分析以确定与使用HDS或有风险的植物使用相关的因素。
■在这个NHANES队列中注册的9685名成年人中,平均年龄(SE)为47.5(0.5)岁,51.8%(95%CI,50.2%-53.4%)为女性。HDS产品使用的总体患病率为57.6%(95%CI,55.9%-59.4%),而使用6种感兴趣的植物药的患病率为4.7%(95%CI,3.9%-5.7%).最常用的是含姜黄的植物药(n=236),其次是含有绿茶的产品(n=92),ashwagandha(n=28),藤黄(n=20),红曲米(n=20),和黑升麻(n=19)。这6种植物药的消费者年龄明显较大(调整后的优势比[AOR],2.36[95%CI,1.06-5.25];40-59岁和AOR的P=.04,3.96[95%CI,1.93-8.11];≥60岁时P=.001),具有较高的教育水平(AOR,4.78[95%CI,2.62-8.75];P<.001),并且更有可能患有关节炎(AOR,2.27[95%CI,1.62-3.29];P<.001)与非HDS用户相比。估计有15584599(95%CI,13047571-18648801)美国成年人在过去30天内至少使用了6种植物产品中的1种,这与处方潜在肝毒性药物的患者数量相似,包括辛伐他汀(14036024[95%CI,11202460-17594452])和非甾体抗炎药(14793837[95%CI,13014623-16671897])。食用姜黄和绿茶的最常见原因是改善或保持健康。
■在这项调查研究中,估计有1560万美国成年人在过去30天内食用了至少一种具有肝脏功能的植物产品,与服用非甾体类抗炎药和常用降血脂药的人数相当。鉴于对植物产品的生产和测试缺乏监管,临床医生应该意识到这些基本不受管制的产品的消费可能导致的不良事件.
UNASSIGNED: Use of herbal and dietary supplements (HDSs) accounts for an increasing proportion of drug hepatotoxicity cases. Turmeric or curcumin, green tea extract, Garcinia cambogia, black cohosh, red yeast rice, and ashwagandha are the most frequently reported hepatoxic botanicals, but their prevalence and reasons for use in the general population are unknown.
UNASSIGNED: To assess the prevalence and clinical characteristics of adult consumers of 6 potentially hepatoxic botanicals.
UNASSIGNED: This survey study analyzed nationally representative data from the National Health and Nutrition Examination Survey (NHANES), a nationally representative, cross-sectional survey of the general US population. Prescription drug and HDS exposure data in the past 30 days were analyzed, and 2020 US Census data were used for population estimates. Data were analyzed July 1, 2023, to February 1, 2024.
UNASSIGNED: Adult NHANES participants enrolled between January 2017 and March 2020.
UNASSIGNED: Baseline weighted characteristics of HDS users and users of 6 potentially hepatotoxic botanical products were compared with non-HDS users. Multivariable analysis was undertaken to identify factors associated with HDS use or at-risk botanical use.
UNASSIGNED: Among 9685 adults enrolled in this NHANES cohort, the mean (SE) age was 47.5 (0.5) years, and 51.8% (95% CI, 50.2%-53.4%) were female. The overall prevalence of HDS product use was 57.6% (95% CI, 55.9%-59.4%), while the prevalence of using the 6 botanicals of interest was 4.7% (95% CI, 3.9%-5.7%). Turmeric-containing botanicals were most commonly used (n = 236), followed by products containing green tea (n = 92), ashwagandha (n = 28), Garcinia cambogia (n = 20), red yeast rice (n = 20), and black cohosh (n = 19). Consumers of these 6 botanicals were significantly older (adjusted odds ratio [AOR], 2.36 [95% CI, 1.06-5.25]; P = .04 for 40-59 years of age and AOR, 3.96 [95% CI, 1.93-8.11]; P = .001 for ≥60 years of age), had a higher educational level (AOR, 4.78 [95% CI, 2.62-8.75]; P < .001), and were more likely to have arthritis (AOR, 2.27 [95% CI, 1.62-3.29]; P < .001) compared with non-HDS users. An estimated 15 584 599 (95% CI, 13 047 571-18 648 801) US adults used at least 1 of the 6 botanical products within the past 30 days, which was similar to the estimated number of patients prescribed potentially hepatotoxic drugs, including simvastatin (14 036 024 [95% CI, 11 202 460-17 594 452]) and nonsteroidal anti-inflammatory drugs (14 793 837 [95% CI, 13 014 623-16 671 897]). The most common reason for consuming turmeric and green tea was to improve or maintain health.
UNASSIGNED: In this survey study, an estimated 15.6 million US adults consumed at least 1 botanical product with liver liability within the past 30 days, comparable with the number of people who consumed nonsteroidal anti-inflammatory drugs and a commonly prescribed hypolipidemic drug. Given a lack of regulatory oversight on the manufacturing and testing of botanical products, clinicians should be aware of possible adverse events from consumption of these largely unregulated products.