0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Brief Communications |

Hepatic Injury in 12 Patients Taking the Herbal Weight Loss Aids Chaso or Onshido

Masayuki Adachi, MD; Hidetsugu Saito, MD, PhD; Hisashi Kobayashi, MD; Yoshinori Horie, MD, PhD; Shinzo Kato, MD, PhD; Masahiro Yoshioka, MD, PhD; and Hiromasa Ishii, MD, PhD
[+] Article and Author Information

From Keio University School of Medicine and Minami Tama Hospital, Tokyo, Japan.


Acknowledgments: The authors thank Drs. Naoko Hanawa, Teikyo University Itabashi Hospital (patient 2); Makiko Kinoshita, Wakayama Coop Hospital (patient 3); Michiko Negishi, Jikei Medical College Hospital (patient 5); Yshihiro Yamada, Mitsukoshi Corporation Clinic (patient 6); Hideaki Miura, Social Insurance Central Hospital (patient 8); Shingo Maeyama, Kaizuka City Hospital (patient 9); and Hiroshi Nakagawara, Tobu-Chiiki Hospital (patient 12), for patient information. The authors also thank Drs. Kanji Wakabayashi, Misa Mizumori, Toshiaki Inamura, Atsushi Sakuraba, Tomoyasu Nishimura, Mihoko Tsuji, and Tomoko Yamashita, Keio University, and Hideo Eno, The Ministry of Health, Labour and Welfare in Japan, for their cooperation.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Hiromasa Ishii, MD, PhD, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.

Current Author Addresses: Drs. Adachi, Saito, Kobayashi, Horie, Kato, and Ishii: Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.

Dr. Yoshioka: Minami Tama Hospital, 3-10-1 Santa-cho, Hachioji-shi, Tokyo, 192-0831, Japan.

Author Contributions: Conception and design: M. Adachi, H. Saito, H. Ishii.

Analysis and interpretation of the data: M. Adachi, H. Saito, H. Kobayashi, Y. Horie, S. Kato, M. Yoshioka, H. Ishii.

Drafting of the article: M. Adachi, H. Saito, H. Ishii.

Critical revision of the article for important intellectual content: M. Adachi, H. Saito, Y. Horie, S. Kato, H. Ishii.

Final approval of the article: M. Adachi, H. Saito, M. Yoshioka, H. Ishii.

Provision of study materials or patients: M. Adachi, H. Saito, H. Kobayashi, M. Yoshioka, H. Ishii.

Statistical expertise: M. Adachi, H. Saito, H. Ishii.

Obtaining of funding: H. Ishii.

Administrative, technical, or logistic support: M. Adachi, H. Saito, H. Kobayashi, S. Kato, H. Ishii.

Collection and assembly of data: M. Adachi, H. Saito, H. Kobayashi, S. Kato, M. Yoshioka, H. Ishii.


Ann Intern Med. 2003;139(6):488-492. doi:10.7326/0003-4819-139-6-200309160-00012
Text Size: A A A

Background: The Chinese herbal dietary supplements Chaso and Onshido are marketed for weight loss in Japan. The safety of these weight loss aids is unknown.

Objective: To describe patients who developed liver injury while taking Chaso or Onshido.

Design: Case series.

Setting: Keio University Hospital, Tokyo, Japan, and other hospitals in Japan.

Patients: 6 patients who took Chaso and 6 patients who took Onshido before presenting with liver injury.

Measurements: Pathologic, clinical, and laboratory evaluations and chemical analysis of the herbal weight loss aids.

Results: All 12 patients developed acute liver injury characterized by a marked increase in serum liver chemistry values (mean alanine aminotransferase level, 1978 U/L [range, 283 to 4074 U/L]) after ingesting these products. Two patients developed fulminant hepatic failure: 1 patient required liver transplantation, and the other patient died. N-nitroso-fenfluramine, a variant of the appetite-depressant drug fenfluramine, was present in these products.

Conclusions: The use of the weight loss aids Chaso and Onshido may be associated with acute liver injury. N-nitroso-fenfluramine is a possible hepatotoxic ingredient.

Figures

Grahic Jump Location
Figure.
Pathologic findings of patients 1 and 7.Top.Middle.Bottom.

Pathologic specimen from the removed liver of patient 1 (hematoxylin and eosin stain; original magnification, ×40). Liver needle biopsy specimen of patient 7, which was performed on hospital day 2 (hematoxylin and eosin stain; original magnification, ×40). Sample from the autopsied liver of patient 7 (hematoxylin and eosin stain; original magnification, ×40).

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Liver Injury in 12 Patients Taking the Herbal Weight Loss Aids Chaso or Onshido

The summary below is from the full report titled “Hepatic Injury in 12 Patients Taking the Herbal Weight Loss Aids Chaso or Onshido.” It is in the 16 September 2003 issue of Annals of Internal Medicine (volume 139, pages 488-492). The authors are M. Adachi, H. Saito, H. Kobayashi, Y. Horie, S. Kato, M. Yoshioka, and H. Ishii.

Read More...

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Journal Club
Related Point of Care
Topic Collections
PubMed Articles
Internet slimming, thyrotoxicosis and the liver. Med J Aust 2014;200(7):419-20.
Controversies in the Diagnosis and Management of NAFLD and NASH. Gastroenterol Hepatol (N Y) 2014;10(4):219-27.
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)