EBM

CRITICAL APPRAISAL
Daily Consumption of an Aqueous Green Tea

Extract Supplement Does Not Impair Liver

Function or Alter Cardiovascular Disease Risk
Biomarkers in Healthy Men

Disusun oleh :
Nama : R.M. Ridho Hidayatulloh
NIM : 1102011215

Dosen Pembimbing :
dr. Taufik Nashrulloh, S.Si

FAKULTAS KEDOKTERAN UNIVERSITAS YARSI

MARET 2014
EBM
Nama : R.M. Ridho Hidayatulloh
NIM : 1102011215
TUGAS EVIDENCE BASED MEDICINE
Skenario
...
Pertanyaan (foreground question)
Apakah teh hijau yang dikonsumsi setiap hari oleh laki-laki dewasa dapat merusak fungsi
hati?
PICO

Population

: Pria Dewasa

Intervention

: Mengkonsumsi the hijau setiap hari

Comparison

: Tidak mengkonsumsi the hijau

Outcomes

: Tidak merusak fungsi hati

Pencarian bukti ilmiah

Alamat website
Kata kunci

: http://www.bmj.com
: men AND green tea AND liver function

Limitasi

: Januari 2003 Desember 2013

Hasil Pencarian

: 67 artikel

Dipilih artikel berjudul

Daily Consumption of an Aqueous Green Tea Extract Supplement Does Not Impair Liver
Function or Alter Cardiovascular Disease Risk Biomarkers in Healthy Men

REVIEW JURNAL
1

Pendahuluan
The limited data on hepatotoxicity induced by dietary GTP in humans are based on case
reports of abnormally high concentrations of liver injury markers. In these patients, cessation
of green tea consumption normalized liver function and resumption of green tea drinking
again elevated these biomarkers . Impaired liver function was observed in participants
regularly consuming as little as 6 cups (;900-1200 mL) per day of green tea or 720 mg/d GTE
(2). On the other hand, GTP were also suggested to protect from hepatic injury. For example,
ingestion of 1 or 2% GTE in the diet for 6 wk reduced ALT and aspartate transaminase (AST)
serum activities in obese but not in lean mice compared with control animals.
Metoda
The trial was designed as a double-blind, placebocontrolled parallel study. The 35 eligible
volunteers were randomized (stratified for age and BMI) into 1 of 2 treatment groups [GTP
(n =18) or placebo (n = 17)] with similar BMI (GTP, 26.0 3.0 kg/m2; placebo, 25.1 3.0
kg/m2; mean SD) and age (GTP, 41.0 9.5 y; placebo, 40.8 9.5 y). Participants took a
total of 6 capsules per day, 2 capsules, together with a glass of water, before each principal
meal, for 3 wk and were instructed to limit their daily tea and coffee consumption to 3
cups (~200 mL each) but to otherwise maintain their normal diet and exercise patterns.
Hasil
Urinary excretion over 24 h of epicatechin and its 3-O- and 4-O-methylated metabolites did
not differ between groups at baseline and was not altered by intake of placebo capsules for 3
wk, but was increased by GTP supplementation postintervention (P 0.0001; Wilcoxons
matched-pairs Signed Rank test). Catechin, its 3-O- and 4-O-methylated metabolites, and
epigallocatechin were not detectable in urine. Cumulative urinary excretion of the - and tocopherol metabolites -CEHC and -CEHC, respectively, and the kidney function
biomarker creatinine were not affected by dietary intervention. The plasma concentrations of
AST, ALT, GGT, bilirubin, urea, uric acid, and albumin were within the physiological ranges
(1319) for all participants at all time points and remained unaltered by GTP intake.
Concentrations of total cholesterol, HDL cholesterol, NEFA, TAG, - and -tocopherol, and
glucose in plasma obtained from fasting participants were not affected by the treatments.
Time (P 0.04) and the time 3 treatment interaction (P 0.03) affected the ratio of
total:HDL cholesterol. Systolic and diastolic blood pressure, plasma ADMA concentrations,
and endothelium-dependent and independent vascular relaxation did not differ between
treatments at baseline and postintervention (data not shown).
Kesimpulan
In conclusion, supplementation of healthy men for 3 wk with a high daily dose of 714 mg
GTP did not cause adverse effects or impair liver and kidney function and did not improve
CVD risk biomarkers other than the ratio of total:HDL cholesterol. Therefore, despite isolated
reports of acute liver failure, a high intake of green tea for 3 wk appears to be safe for healthy
men.

APAKAH HASIL PENELITIAN TERSEBUT VALID?

2

A. Petunjuk Primer
1. Apakah terdapat sampel yang representatif, terdefinisi jelas, dan berada pada kondisi yang
sama dalam perjalanan penyakitnya?

2. Apakah follow-up cukup lama dan lengkap?

B. Petunjuk sekunder
1. Apakah kriteria outcome yang digunakan obyektif dan tanpa bias?

2. Bila ditemukan subgrup dengan prognosis yang beda, apakah dilakukan adjustment untuk
faktor-faktor prognostik yang penting?

3. Apakah dilakukan validasi pada suatu kelompok independen (test-set)?

APA HASILNYA?
3

1. Bagaimana gambaran outcome menurut waktu?

2. Seberapa tepat perkiraan prognosis?

APAKAH HASIL PENELITIAN INI DAPAT DIAPLIKASIKAN?

1. Apakah pasien dalam penelitian tersebut serupa dengan pasien saya?

2. Apakah hasil tersebut membantu memilih atau menghindari terapi tertentu?

3. Apakah hasilnya membantu dalam memberikan konseling kepada pasien saya?
.