Assessing the use of prescription drugs and dietary supplements in obese respondents in the National Health and Nutrition Examination Survey

Barrett, Laura A.; Xing, Aiwen; Sheffler, Julia; Steidley, Elizabeth; Adam, Terrence J.; Zhang, Rui; He, Zhe

doi:10.1371/journal.pone.0269241

Cited by 2 publications

(2 citation statements)

References 48 publications

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“…The epidemic of obesity is associated with a steady rise in drug consumption in order to treat several associated diseases such as type 2 diabetes mellitus (T2DM), hypertension, atherosclerosis, dyslipidemia and osteoarthritis [ 1 , 2 ]. In addition, numerous drugs are currently being developed in order to specifically treat nonalcoholic fatty liver disease (NAFLD), which is frequently associated with obesity and overweight [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Acetaminophen-Induced Hepatotoxicity in Obesity and Nonalcoholic Fatty Liver Disease: A Critical Review

Begriche¹,

Penhoat²,

Bernabeu-Gentey³

et al. 2023

Livers

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The epidemic of obesity, type 2 diabetes and nonalcoholic liver disease (NAFLD) favors drug consumption, which augments the risk of adverse events including liver injury. For more than 30 years, a series of experimental and clinical investigations reported or suggested that the common pain reliever acetaminophen (APAP) could be more hepatotoxic in obesity and related metabolic diseases, at least after an overdose. Nonetheless, several investigations did not reproduce these data. This discrepancy might come from the extent of obesity and steatosis, accumulation of specific lipid species, mitochondrial dysfunction and diabetes-related parameters such as ketonemia and hyperglycemia. Among these factors, some of them seem pivotal for the induction of cytochrome P450 2E1 (CYP2E1), which favors the conversion of APAP to the toxic metabolite N-acetyl-p-benzoquinone imine (NAPQI). In contrast, other factors might explain why obesity and NAFLD are not always associated with more frequent or more severe APAP-induced acute hepatotoxicity, such as increased volume of distribution in the body, higher hepatic glucuronidation and reduced CYP3A4 activity. Accordingly, the occurrence and outcome of APAP-induced liver injury in an obese individual with NAFLD would depend on a delicate balance between metabolic factors that augment the generation of NAPQI and others that can mitigate hepatotoxicity.

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Section: Introductionmentioning

confidence: 99%

Acetaminophen-Induced Hepatotoxicity in Obesity and Nonalcoholic Fatty Liver Disease: A Critical Review

Begriche¹,

Penhoat²,

Bernabeu-Gentey³

et al. 2023

Livers

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“…[38][39][40] Use of HDSs has also been shown to be more prevalent among individuals with chronic medical conditions, including cardiovascular disorders, cancer, and obesity. 26,[40][41][42][43][44][45][46][47] In our study, we found diabetes, arthritis, and thyroid disorder independently associated with HDS use, but not cardiovascular disorder or cancer.…”

Section: Discussionmentioning

confidence: 77%

Estimated Exposure to 6 Potentially Hepatotoxic Botanicals in US Adults

Likhitsup,

Chen,

Fontana

2024

JAMA Netw Open

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ImportanceUse 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.ObjectiveTo assess the prevalence and clinical characteristics of adult consumers of 6 potentially hepatoxic botanicals.Design, Setting, and ParticipantsThis 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.ExposuresAdult NHANES participants enrolled between January 2017 and March 2020.Main Outcomes and MeasuresBaseline 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.ResultsAmong 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 &lt; .001), and were more likely to have arthritis (AOR, 2.27 [95% CI, 1.62-3.29]; P &lt; .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.Conclusions and RelevanceIn 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.

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Assessing the use of prescription drugs and dietary supplements in obese respondents in the National Health and Nutrition Examination Survey

Cited by 2 publications

References 48 publications

Acetaminophen-Induced Hepatotoxicity in Obesity and Nonalcoholic Fatty Liver Disease: A Critical Review

Acetaminophen-Induced Hepatotoxicity in Obesity and Nonalcoholic Fatty Liver Disease: A Critical Review

Estimated Exposure to 6 Potentially Hepatotoxic Botanicals in US Adults

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