David Geffen School of Medicine, University of California, Los Angeles, California, USA.
Icahn School of Medicine, Mt. Sinai Health, New York, New York, USA.
Aliment Pharmacol Ther. 2024 Aug;60(4):479-483. doi: 10.1111/apt.18116. Epub 2024 Jun 14.
In April 2022, French Lentil and Leek Crumble (FLLC), a new frozen food preparation manufactured by Daily Harvest™ (containing Tara flour) was offered as a natural high-protein meal product. Soon thereafter, widespread anecdotal reports of acute gastrointestinal symptoms with liver injury were reported, leading to its voluntary withdrawal in June 2022, after shipment of 28,000 preparations.
To summarise the clinical and laboratory features of 17 patients with FLLC associated liver injury from the Drug Induced Liver Injury Network (DILIN).
Patients with FLLC-associated liver injury were enrolled into a prospective protocol and followed for 6 months. Cases were adjudicated by expert opinion causality assessment with summary statistics for data analysis.
Enrolled subjects had a mean age of 41 years, 82% were female with mean BMI of 24 kg/m. All were Caucasian without underlying liver disease. In most cases, abdominal pain and nausea arose within hours of FLLC ingestion. Mean days from ingestion to identification of liver injury was 3.1 days (±2.8). On enrolment, 53% had jaundice, 47% nausea, 24% fever, 59% abdominal pain, 41% itching and 12% rash. The mean initial serum ALT was 475 U/L (±302), AST 315 U/L (±315), alkaline phosphatase 190 U/L (±76), with a total bilirubin of 2.6 mg/dL (±2). In this study, 63% presented with a hepatocellular pattern of liver injury, 6% cholestatic and 31% mixed as determined by the R value. In addition, 24% of patients were hospitalised, and there were no fatalities or liver transplants. Liver biopsy in one subject revealed acute hepatitis with mild ductular reaction, mild lymphocytic and eosinophilic portal inflammation, mild lobular inflammation, preserved bile ducts and absence of interface hepatitis, steatosis, granulomatous reaction or cholestasis. Phylogenetic analysis confirmed the presence of Tara spinosa, the source of Tara flour.
Natural food products are increasingly ubiquitous and may unexpectedly cause significant illness. All clinicians should inquire whether patients are consuming natural food products or herbal supplements and consider them as a potential cause of liver injury.
2022 年 4 月，由 Daily Harvest ™生产的一种新型冷冻食品——法式扁豆韭菜馅饼（FLLC），作为高蛋白天然餐食推出。此后不久，便有广泛的传闻报道称食用该产品后出现急性胃肠道症状和肝损伤，导致该产品于 2022 年 6 月自愿下架，当时已出货 2.8 万份。
总结来自药物性肝损伤网络（DILIN）的 17 例与 FLLC 相关的肝损伤患者的临床和实验室特征。
将 FLLC 相关肝损伤患者纳入前瞻性方案，并随访 6 个月。通过专家意见因果关系评估进行病例判定，并采用汇总统计数据进行数据分析。
入组患者的平均年龄为 41 岁，82%为女性，平均 BMI 为 24kg/m2。所有患者均为高加索人，无潜在的肝脏疾病。在大多数情况下，食用 FLLC 后数小时内出现腹痛和恶心。从食用到发现肝损伤的平均时间为 3.1 天（±2.8）。入组时，53%有黄疸，47%有恶心，24%有发热，59%有腹痛，41%有瘙痒，12%有皮疹。初始血清 ALT 平均值为 475U/L（±302），AST 平均值为 315U/L（±315），碱性磷酸酶平均值为 190U/L（±76），总胆红素为 2.6mg/dL（±2）。在这项研究中，63%的患者表现为肝细胞性肝损伤，6%为胆汁淤积性，31%为混合性，这是根据 R 值确定的。此外，24%的患者住院，无死亡或肝移植病例。1 例患者的肝活检显示为急性肝炎，伴有轻度胆管反应、轻度淋巴细胞和嗜酸性门脉炎症、轻度肝小叶炎症、保留的胆管和无界面肝炎、脂肪变性、肉芽肿反应或胆汁淤积。系统发生分析证实存在 Tara 旋花，这是 Tara 面粉的来源。
天然食品越来越普及，可能会意外导致严重疾病。所有临床医生都应询问患者是否食用天然食品或草药补充剂，并将其视为肝损伤的潜在原因。
