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. 2022 Dec 12;20(6):181–187. doi: 10.1002/cld.1254

TABLE 2.

Overview of systemic reviews

Author Study type Data Supplements Intake type Intake duration until liver damage Authors’ conclusion
Sarma et al. (2008) 2 Safety review Case reports of experimental and clinical data (n = 216) GTE (multi‐ingredient supplement Oral application 5–120 days Expert Committee concluded that the safety information for green tea arising from diverse sources provides a signal for the possibility of liver damage caused by products that contain concentrated GTEs
Liver damage possible (n = 27)
Liver damage probable (n = 7)
(1966–2007)
Mazzanti et al. (2009) 5 Review Case reports (n = 34) GTE (n = 15) Oral application 4–1460 days Analysis of the published case reports suggests a causal association between green tea and liver damage
(1999–2008) Multicomponent preparations (n = 19)
Mazzanti et al. (2015) 4 Review Case reports (n = 19) GTE (multi‐ingredient supplement) Oral application 14–365 days Safety concern with GTE especially when green tea is associated with other ingredients
(2008–2015)
Oketch‐Rabah et al. (2019) 6 Safety review Experimental animal studies (n = 127) GTE (different compositions) Oral application >14 days Animal and human data indicate that repeated oral administration of bolus doses of GTE during fasting significantly increases bioavailability of catechins
Clinical data (n = 355) Case reports associate hepatotoxicity with EGCG intake amounts from 140 mg to ∼1000 mg/day and substantial interindividual variability in susceptibility, possibly because of genetic factors
Clinical trials (n = 4) Toxicological studies show a hepatocellular pattern of liver injury
Published case reports (n = 51)
Reviews and miscellaneous reports (n = 52 + 35)
(2008–2016)
Hoofnagle et al. (2021) 7 Retrospective analysis 40 cases of green tea–associated liver injury 3% of 1414 DILIN patients GTE (multi‐ingredient supplement) Oral application 15–448 days (median 72 days) The liver injury was typically hepatocellular (95%) with marked serum aminotransferase elevations and modest increases in alkaline phosphatase. Severe course in 14 patients (35%), liver transplantation in 3 (8%), and chronic injury 12 patients (3%). HLA typing indicated a high prevalence of HLA‐B*35:01, found in 72% (95% CI: 58%‐87%) of green tea cases, but only 15% (95% CI: 10%‐20%) caused by other supplements and 12% (95% CI: 10%‐14%) attributed to drugs, the latter rate being similar to population controls (95% CI: 10.5%‐11.5%), suggesting that it is idiosyncratic and immune mediated
(2004–2018)