HDS-induced liver injury now accounts for 20% of cases of liver toxicity in the United States Drug Induced Liver Injury Network, a research network that has been funded to study drug and supplement toxicity since 2003. The major implicated agents include products used for performance enhancement, bodybuilding, and weight loss. The injurious components of multi-ingredient nutritional supplements that are responsible for liver toxicity often can only be suspected.

"Considerable efforts are needed to identify potentially injurious ingredients of HDSs and to prohibit or more closely regulate them," said Dr. Victor Navarro, lead author of the Hepatology review.