检索问题
维生素、矿物质等各类补剂会增加肝脏负担么
维生素和矿物质等各类饮食补充剂的使用在现代社会日益普及，尤其是在追求健康生活方式的 individual 中更是如此。然而，近年来的研究和临床案例揭示了某些补充剂可能会对肝脏健康造成潜在影响，甚至增加肝脏的负担。以下是与此主题相关的多个证据的综合分析，旨在探讨补充剂对肝脏的影响。
1. 饮食补充剂的种类和用途
饮食补充剂的形式多种多样，包括维生素、矿物质、植物提取物、氨基酸等，其主要目的是补充日常饮食中不足的营养素，促进健康或增强运动表现。许多人为了改善身体健康或运动表现，选择使用这些补充剂。
2. 维生素、矿物质对肝脏的影响
尽管维生素和矿物质在促进身体健康方面扮演着重要角色，但过量摄入或不当选择可能会危害肝脏。例如，有研究报道，某些成分如铜可以导致重度毒性，包括肝衰竭、肌肉溶解等，并且这些症状在使用过量补充剂的健美者中尤为明显。铜中毒的病例，常常显示与多种补充剂的使用相关，突显了补充剂成分的潜在危险。
在另一项研究中，特定的草本补充剂（如牛分裂叶（Chaparral））已被证明与肝毒性相关。根据 FDA 提供的18例病例报告，饮用牛分裂叶的患者中，有13例出现了肝毒性，临床表现为黄疸和肝功能显著异常，这种病理表现通常发生在停用补充剂后数周内恢复。这些发现表明，某些特定的植物性补充剂可能会增加肝脏负担，造成严重的健康问题。
3. 饮食习惯和非酒精性脂肪肝病（NAFLD）
饮食和生活方式对肝脏健康有着深远影响。非酒精性脂肪肝病（NAFLD）已成为发达国家中最常见的健康问题之一，其发病与不良饮食习惯（如过量卡路里、过多碳水化合物和脂肪摄入）密切相关。这种情况说明，改善饮食习惯和适度使用补充剂可能有助于减轻肝脏负担，而过量和不适合的饮食补充剂则可能加重脂肪肝的发展。
4. 补充剂与药物相互作用
使用补充剂时，还需关注其与现有药物的相互作用。某些营养素可能会影响药物的代谢和清除。例如，在接受化疗的患者中，如果不适当使用维生素和矿物质补充剂，可能会影响化疗药物的效果，进一步增加肝脏的负担。因此，在存在肝病或使用其他药物的情况下，患者应在专业人士的指导下选择补充剂。
5. COVID-19与肝功能
COVID-19大流行凸显了营养在疾病管理中的重要性。研究表明，在COVID-19患者中，肝功能障碍并不罕见，且在某些情况下，肝功能的程度与疾病的严重程度成正比。在这种背景下，适当的营养干预（包括使用某些补充剂）可能具有肝脏保护作用，反之亦然，一些补充剂不当使用可能加重肝脏负担。
6. 临床案例分析
临床实践中，饮食补充剂与肝损伤之间的因果关系也被广泛讨论。比如在一例高龄患者中，服用特定的膳食补充剂后出现肝功能异常，停药后症状得到改善，表明该补充剂可能与肝损伤相关。在临床中，特别是对老年人，医生常常需要询问患者的补充剂使用情况，以排除这些可能导致肝功能障碍的因素。
结论
总体而言，维生素、矿物质以及其他饮食补充剂在一定程度上可以促进健康，但误用、过量或不当的选择可能会对肝脏带来负担。特别是某些草本产品和微量元素如果过量使用，可能会导致肝脏损害的风险增加。因此，在这方面，应该提倡更为理智和科学的使用姿态：补充剂的使用应在专业人士的指导下进行，特别是对于已有肝病或服用其他药物的患者。此外，健康的饮食习惯和生活方式能够在最大程度上促进肝脏的健康，应成为人们关注的重点。
References
1Chaparral-associated hepatotoxicity.PubMed
N M Sheikh, R M Philen, L A Love
Arch Intern Med. 1997 Apr 28;157(8):913-9.
BACKGROUND: Personal health care practices that may include the use of dietary supplements are common in the United States. Products marketed as dietary supplements are diverse and may include botanicals, vitamins, and/or minerals. Chaparral (Larrea tridentata) is a botanical dietary supplement made from a desert shrub and used for its antioxidant properties. Several reports of chaparral-associated hepatitis have been published since 1990, but a complete picture of the clinical presentation is still unclear. MATERIALS AND METHODS: We reviewed the 18 case reports of adverse events associated with the ingestion of chaparral reported to the Food and Drug Administration between 1992 and 1994. These reports were from health care professionals, state health departments, and individual consumers. RESULTS: Of 18 reports of illnesses associated with the ingestion of chaparral, there was evidence of hepatotoxicity in 13 cases. Clinical presentation, characterized as jaundice with a marked increase in serum liver chemistry values, occurred 3 to 52 weeks after the ingestion of chaparral, and it resolved 1 to 17 weeks after most individuals stopped their intake of chaparral. The predominant pattern of liver injury was characterized as toxic or drug-induced cholestatic hepatitis; in 4 individuals, there was progression to cirrhosis; and in 2 individuals, there was acute fulminant liver failure that required liver transplants. CONCLUSIONS: These data indicate that the use of chaparral may be associated with acute to chronic irreversible liver damage with fulminant hepatic failure, and they underscore the potential for certain dietary supplement ingredients to cause toxic effects on the liver. Health professionals should be encouraged to inquire routinely about the use of dietary supplements and other products, to be alert to potential adverse effects that may be associated with these products, and, finally, to report any serious adverse events associated with these products through the MEDWatch Program of the Food and Drug Administration.
2Dietary habits and behaviors associated with nonalcoholic fatty liver disease.PubMed
Kenichiro Yasutake, Motoyuki Kohjima, Kazuhiro Kotoh, et al.
World J Gastroenterol. 2014 Feb 21;20(7):1756-67. doi: 10.3748/wjg.v20.i7.1756.
Nonalcoholic fatty liver disease (NAFLD) is one of the most frequent causes of health problems in Western (industrialized) countries. Moreover, the incidence of infantile NAFLD is increasing, with some of these patients progressing to nonalcoholic steatohepatitis. These trends depend on dietary habits and life-style. In particular, overeating and its associated obesity affect the development of NAFLD. Nutritional problems in patients with NAFLD include excess intake of energy, carbohydrates, and lipids, and shortages of polyunsaturated fatty acids, vitamins, and minerals. Although nutritional therapeutic approaches are required for prophylaxis and treatment of NAFLD, continuous nutrition therapy is difficult for many patients because of their dietary habits and lifestyle, and because the motivation for treatment differs among patients. Thus, it is necessary to assess the nutritional background and to identify nutritional problems in each patient with NAFLD. When assessing dietary habits, it is important to individually evaluate those that are consumed excessively or insufficiently, as well as inappropriate eating behaviors. Successful nutrition therapy requires patient education, based on assessments of individual nutrients, and continuing the treatment. In this article, we update knowledge about NAFLD, review the important aspects of nutritional assessment targeting treatment success, and present some concrete nutritional care plans which can be applied generally.
3Micronutrient Food Supplements in Patients with Gastro-Intestinal and Hepatic Cancers.PubMed
Waqas Alam, Hammad Ullah, Cristina Santarcangelo, et al.
Int J Mol Sci. 2021 Jul 27;22(15):8014. doi: 10.3390/ijms22158014.
Colorectal carcinogenesis is the second most common cause of mortality across all types of malignancies, followed by hepatic and stomach cancers. Chemotherapy and radiotherapy are key approaches to treating cancer patients, but these carry major concerns, such as a high risk of side effects, poor accessibility, and the non-selective nature of chemotherapeutics. A number of natural products have been identified as countering various forms of cancer with fewer side effects. The potential impact of vitamins and minerals on long-term health, cognition, healthy development, bone formation, and aging has been supported by experimental and epidemiological studies. Successful treatment may thus be highly influenced by the nutritional status of patients. An insufficient diet could lead to detrimental effects on immune status and tolerance to treatment, affecting the ability of chemotherapy to destroy cancerous cells. In recent decades, most cancer patients have been taking vitamins and minerals to improve standard therapy and/or to decrease the undesirable side effects of the treatment together with the underlying disease. On the other hand, taking dietary supplements during cancer therapy may affect the effectiveness of chemotherapy. Thus, micronutrients in complementary oncology must be selected appropriately and should be taken at the right time. Here, the potential impact of micronutrients on gastro-intestinal and hepatic cancers is explored and their molecular targets are laid down.
4COVID-19 and liver dysfunction: What nutritionists need to know.PubMed
Ming-Ke Wang, Xue-Lu Yu, Li-Yun Zhou, et al.
World J Gastroenterol. 2022 Apr 21;28(15):1526-1535. doi: 10.3748/wjg.v28.i15.1526.
The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus-2 has brought serious challenges for the medical field. Patients with COVID-19 usually have respiratory symptoms. However, liver dysfunction is not an uncommon presentation. Additionally, the degree of liver dysfunction is associated with the severity and prognosis of COVID-19. Prevention, diagnosis, and treatment of malnutrition should be routinely recommended in the management of patients with COVID-19, especially in those with liver dysfunction. Recently, a large number of studies have reported that nutrition therapy measures, including natural dietary supplements, vitamins, minerals and trace elements, and probiotics, might have potential hepatoprotective effects against COVID-19-related liver dysfunction their antioxidant, antiviral, anti-inflammatory, and positive immunomodulatory effects. This review mainly focuses on the possible relationship between COVID-19 and liver dysfunction, nutritional and metabolic characteristics, nutritional status assessment, and nutrition therapy to provide a reference for the nutritionists while making evidence-based nutritional decisions during the COVID-19 pandemic.
5Bodybuilding supplements leading to copper toxicity, encephalopathy, fulminant hepatic failure and rhabdomyolysis.PubMed
John R Richards, Pieter H Scheerlinck, Kelly P Owen, et al.
Am J Emerg Med. 2020 Nov;38(11):2487.e1-2487.e5. doi: 10.1016/j.ajem.2020.05.096. Epub 2020 Jun 2.
Millions of people worldwide use nutritional and dietary supplements, such as vitamins and minerals. These and other performance-enhancing substances are also used by high school, college, and professional athletes, bodybuilders, and amateur sports enthusiasts. The constituents of these supplements and their metabolites may be harmful and not listed on the product label. We present a case report of a 32-year-old bodybuilder using myriad nutritional, performance-enhancing, and weight-loss supplements with life-threatening encephalopathy, hepatic failure, rhabdomyolysis, and copper toxicity mimicking Wilson's disease. Emergency physicians and nurses should be aware of these potential deleterious effects and inquire about supplement use by patients with unexplained multiorgan failure. Family, friends, or acquaintances should be asked to bring the actual products to the hospital for analysis.
6Potential of nutraceuticals in celiac disease.PubMed
Mahtab Jahdkaran, Nastaran Asri, Hadi Esmaily, et al.
Tissue Barriers. 2025;13(2):2374628. doi: 10.1080/21688370.2024.2374628. Epub 2024 Jun 30.
Celiac Disease (CD) is the most common hereditarily-based food intolerance worldwide and a chronic inflammatory condition. The current standard treatment for CD involves strict observance and compliance with a gluten-free diet (GFD). However, maintaining a complete GFD poses challenges, necessitating the exploration of alternative therapeutic approaches. Nutraceuticals, bioactive products bridging nutrition and pharmaceuticals, have emerged as potential candidates to regulate pathways associated with CD and offer therapeutic benefits. Despite extensive research on nutraceuticals in various diseases, their role in CD has been relatively overlooked. This review proposes comprehensively assessing the potential of different nutraceuticals, including phytochemicals, fatty acids, vitamins, minerals, plant-based enzymes, and dietary amino acids, in managing CD. Nutraceuticals exhibit the ability to modulate crucial CD pathways, such as regulating gluten fragment accessibility and digestion, intestinal barrier function, downregulation of tissue transglutaminase (TG2), intestinal epithelial morphology, regulating innate and adaptive immune responses, inflammation, oxidative stress, and gut microbiota composition. However, further investigation is necessary to fully elucidate the underlying cellular and molecular mechanisms behind the therapeutic and prophylactic effects of nutraceuticals for CD. Emphasizing such research would contribute to future developments in CD therapies and interventions.
7Adverse reaction to a dietary supplement in an elderly patient.PubMed
Rebecca B Sleeper, Shalyn M Kennedy
Ann Pharmacother. 2003 Jan;37(1):83-6. doi: 10.1345/aph.1C186.
OBJECTIVE: To describe the case of an elderly patient who experienced hepatic enzyme elevations and symptoms of hepatitis associated with the administration of a dietary supplement. CASE SUMMARY: A 92-year-old white woman with no history of hepatic disease developed jaundice and increased confusion associated with increased hepatic enzymes. The hepatitis panel, abdominal ultrasound, and antinuclear antibody screen indicated no abnormalities. A drug regimen review revealed that the patient was receiving a dietary supplement, Nutrilite Double X Multivitamin-Multimineral. Following discontinuation of the supplement, the patient's symptoms resolved and the hepatic enzymes decreased or returned to the reference range at evaluations occurring 1 week and 1 month after intervention. An objective causality assessment revealed this to be a probable adverse drug event. DISCUSSION: While the association of certain herbal preparations with hepatotoxicity has been demonstrated, the potential for this adverse effect is easily overlooked. In this patient, infectious or autoimmune causes of acute hepatitis were ruled out, and drug-induced causes were considered. The resolution of symptoms and laboratory values following discontinuation of the supplement support a relationship between the dietary supplement and this episode of hepatitis. CONCLUSIONS: Our case indicates that there was a probable relationship between the dietary supplement Nutrilite Double X Multivitamin-Multimineral and the development of acute hepatitis. Due to the multi-ingredient formulation of the product, as well as lack of data describing manufacturing procedures, it is difficult to determine which component may be associated with this effect. Over-the-counter supplements should be considered as a part of the differential diagnosis in patients presenting with increased liver enzymes and related symptoms.
检索问题
维生素、矿物质等各类补剂会增加肝脏负担么
关于维生素、矿物质等补充剂对肝脏负担的影响，这一问题涉及多个方面，包括补充剂的种类、用量、个体的健康状况以及潜在的药物相互作用。以下是从不同研究中的证据和见解归纳出的详细回答。
1. 肝脏的功能与负担
肝脏是体内主要的解毒器官，负责代谢药物、酒精和多种营养素。任何外源性物质，包括营养补充剂，都可能对肝脏的代谢功能产生影响。如果补充剂摄入过量，或者与肝脏疾病、潜在的药物相互作用或不适合的状态相结合，可能会增加肝脏的负担。
2. 维生素与矿物质的补充
某些维生素（尤其是脂溶性维生素如维生素A、D、E和K）如果过量，很可能在肝脏中积累，造成毒性反应。例如，过量的维生素A可引起肝脏损伤，而维生素D过量则可能导致高钙血症，进一步影响肝功能。在癌症患者中，尤其是接受化疗的患者，维生素和矿物质补充被普遍使用，既希望改善治疗效果，也希望减轻副作用，但这也需要在医生指导下进行，以避免潜在的不良影响。
3. 降低肝脏负担的营养措施
另一方面，适量的营养补充可以发挥保护肝脏的作用。针对COVID-19相关肝功能障碍的研究表明，适当的营养干预如维生素、矿物质和益生菌可以发挥抗氧化、抗炎和免疫调节等积极效果。这显示出在特定情况下，某些补充剂可能对肝脏有保护作用，而不是增加负担。
4. 个体差异
肝脏对补充剂的反应因个体差异而异。例如，肝脏功能受损的患者在使用补充剂时需格外小心，因为他们的肝脏解毒能力较差，可能更容易受到不良影响。因此，使用补充剂时应考虑个人的健康状况、现有疾病及其严重程度，以及正在使用的其他药物。
5. 结论与建议
总的来说，虽然维生素及矿物质补充剂在适当的剂量下，可以对健康产生正面影响，但若不当使用，确实有可能增加肝脏负担。特别是在存在肝脏疾病的患者或与某些药物相互作用的情况下，使用补充剂需谨慎。建议在使用任何补剂之前，咨询医生或营养师，以确保安全、有效，避免不必要的风险。
综上所述，维生素、矿物质等补剂的使用需因人而异，科学的评估和适当的管理是确保其益处最大化和风险最小化的关键。
References
1Potential of nutraceuticals in celiac disease.PubMed
Mahtab Jahdkaran, Nastaran Asri, Hadi Esmaily, et al.
Tissue Barriers. 2025;13(2):2374628. doi: 10.1080/21688370.2024.2374628. Epub 2024 Jun 30.
Celiac Disease (CD) is the most common hereditarily-based food intolerance worldwide and a chronic inflammatory condition. The current standard treatment for CD involves strict observance and compliance with a gluten-free diet (GFD). However, maintaining a complete GFD poses challenges, necessitating the exploration of alternative therapeutic approaches. Nutraceuticals, bioactive products bridging nutrition and pharmaceuticals, have emerged as potential candidates to regulate pathways associated with CD and offer therapeutic benefits. Despite extensive research on nutraceuticals in various diseases, their role in CD has been relatively overlooked. This review proposes comprehensively assessing the potential of different nutraceuticals, including phytochemicals, fatty acids, vitamins, minerals, plant-based enzymes, and dietary amino acids, in managing CD. Nutraceuticals exhibit the ability to modulate crucial CD pathways, such as regulating gluten fragment accessibility and digestion, intestinal barrier function, downregulation of tissue transglutaminase (TG2), intestinal epithelial morphology, regulating innate and adaptive immune responses, inflammation, oxidative stress, and gut microbiota composition. However, further investigation is necessary to fully elucidate the underlying cellular and molecular mechanisms behind the therapeutic and prophylactic effects of nutraceuticals for CD. Emphasizing such research would contribute to future developments in CD therapies and interventions.
2COVID-19 and liver dysfunction: What nutritionists need to know.PubMed
Ming-Ke Wang, Xue-Lu Yu, Li-Yun Zhou, et al.
World J Gastroenterol. 2022 Apr 21;28(15):1526-1535. doi: 10.3748/wjg.v28.i15.1526.
The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus-2 has brought serious challenges for the medical field. Patients with COVID-19 usually have respiratory symptoms. However, liver dysfunction is not an uncommon presentation. Additionally, the degree of liver dysfunction is associated with the severity and prognosis of COVID-19. Prevention, diagnosis, and treatment of malnutrition should be routinely recommended in the management of patients with COVID-19, especially in those with liver dysfunction. Recently, a large number of studies have reported that nutrition therapy measures, including natural dietary supplements, vitamins, minerals and trace elements, and probiotics, might have potential hepatoprotective effects against COVID-19-related liver dysfunction their antioxidant, antiviral, anti-inflammatory, and positive immunomodulatory effects. This review mainly focuses on the possible relationship between COVID-19 and liver dysfunction, nutritional and metabolic characteristics, nutritional status assessment, and nutrition therapy to provide a reference for the nutritionists while making evidence-based nutritional decisions during the COVID-19 pandemic.
3Micronutrient Food Supplements in Patients with Gastro-Intestinal and Hepatic Cancers.PubMed
Waqas Alam, Hammad Ullah, Cristina Santarcangelo, et al.
Int J Mol Sci. 2021 Jul 27;22(15):8014. doi: 10.3390/ijms22158014.
Colorectal carcinogenesis is the second most common cause of mortality across all types of malignancies, followed by hepatic and stomach cancers. Chemotherapy and radiotherapy are key approaches to treating cancer patients, but these carry major concerns, such as a high risk of side effects, poor accessibility, and the non-selective nature of chemotherapeutics. A number of natural products have been identified as countering various forms of cancer with fewer side effects. The potential impact of vitamins and minerals on long-term health, cognition, healthy development, bone formation, and aging has been supported by experimental and epidemiological studies. Successful treatment may thus be highly influenced by the nutritional status of patients. An insufficient diet could lead to detrimental effects on immune status and tolerance to treatment, affecting the ability of chemotherapy to destroy cancerous cells. In recent decades, most cancer patients have been taking vitamins and minerals to improve standard therapy and/or to decrease the undesirable side effects of the treatment together with the underlying disease. On the other hand, taking dietary supplements during cancer therapy may affect the effectiveness of chemotherapy. Thus, micronutrients in complementary oncology must be selected appropriately and should be taken at the right time. Here, the potential impact of micronutrients on gastro-intestinal and hepatic cancers is explored and their molecular targets are laid down.