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<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE" /><meta name="citation_inbook_title" content="LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]" /><meta name="citation_title" content="Noni" /><meta name="citation_publisher" content="National Institute of Diabetes and Digestive and Kidney Diseases" /><meta name="citation_date" content="2020/03/28" /><meta name="citation_pmid" content="31643695" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK548374/" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Noni" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="National Institute of Diabetes and Digestive and Kidney Diseases" /><meta name="DC.Date" content="2020/03/28" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK548374/" /><meta name="description" content="Noni is a tropic fruit tree, the juice, roots, stems, bark, leaves and flowers of which have been used as medicinal remedies in Polynesia for centuries and recently in the Western world for a wide range of medical problems from cancer and diabetes to AIDs. A small number of isolated case reports of clinically apparent liver injury have been attributed to noni." /><meta name="og:title" content="Noni" /><meta name="og:type" content="book" /><meta name="og:description" content="Noni is a tropic fruit tree, the juice, roots, stems, bark, leaves and flowers of which have been used as medicinal remedies in Polynesia for centuries and recently in the Western world for a wide range of medical problems from cancer and diabetes to AIDs. A small number of isolated case reports of clinically apparent liver injury have been attributed to noni." /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK548374/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-livertox-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/livertox/Noni/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK548374/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" media="print" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} .body-content h2, .body-content .h2 {border-bottom: 1px solid #97B0C8} .body-content h2.inline {border-bottom: none} a.page-toc-label , .jig-ncbismoothscroll a {text-decoration:none;border:0 !important} .temp-labeled-list .graphic {display:inline-block !important} .temp-labeled-list img{width:100%}</style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript" src="/corehtml/pmc/js/large-obj-scrollbars.min.js"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script><meta name="book-collection" content="NONE" />
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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="All Drug Records" href="/books/n/livertox/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-livertox-lrg.png" alt="Cover of LiverTox" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK548374_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK548374_dtls__"><div>Bethesda (MD): <a href="https://www.niddk.nih.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Institute of Diabetes and Digestive and Kidney Diseases</a>; 2012-.</div></div><div class="half_rhythm"><ul class="inline_list"><li style="margin-right:1em"><a class="bk_cntns" href="/books/n/livertox/">Drug Records</a></li></ul></div><div class="bk_noprnt"><form method="get" action="/books/n/livertox/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div><div class="icnblk_cntnt two_col"><div class="pagination bk_noprnt"><a class="active page_link prev" href="/books/n/livertox/Nizatidine/" title="Previous page in this title">< Prev</a><a class="active page_link next" href="/books/n/livertox/NonsteroidalAntiinfl/" title="Next page in this title">Next ></a></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK548374_"><span class="title" itemprop="name">Noni</span></h1><p class="small">Last Update: <span itemprop="dateModified">March 28, 2020</span>.</p></div><div class="body-content whole_rhythm" itemprop="text"><div id="Noni.OVERVIEW"><h2 id="_Noni_OVERVIEW_">OVERVIEW</h2><div id="Noni.Introduction"><h3>Introduction</h3><p>Noni is a tropic fruit tree, the juice, roots, stems, bark, leaves and flowers of which have been used as medicinal remedies in Polynesia for centuries and recently in the Western world for a wide range of medical problems from cancer and diabetes to AIDs. A small number of isolated case reports of clinically apparent liver injury have been attributed to noni.</p></div><div id="Noni.Background"><h3>Background</h3><p>Morinda citrifolia is a small, tropic fruit tree commonly known as Indian Mulberry, Ba Ji Tian or Noni which has been used as a food and an herbal remedy for centuries in Polynesia and Southeast Asia. Recently, noni has been introduced into Western herbal medicine as a “tropic fruit with 101 medical uses”, and widely advertised and sold on the internet for a wide range of disorders including cancer, diabetes, depression, chronic fatigue, AIDS and senility. Active components in noni are many and include flavonoids, glycosides, vitamins, anthraquinones and polyunsaturated fatty acids. Studies in vitro and in animal models suggest that the active components are polysaccharide rich substances which have antitumor effects in vitro. In clinical trials, however, noni has yet to be proven to have anticancer activity. Noni juice has been marketed in the United States since 1996 and was approved as a “novel food” by the European Commission in 2003. While considered safe, several case reports of adverse events attributed to use of noni have appeared, although often criticized because of lack of chemical analysis of the actual product to exclude misidentification and contamination.</p></div><div id="Noni.Hepatotoxicity"><h3>Hepatotoxicity</h3><p>Several case reports have suggested that noni may account for some cases of idiosyncratic acute liver injury, although the association was weak in many cases. The latency to onset ranged from 2 to 8 weeks and the clinical features resembled acute hepatitis with a hepatocellular pattern of serum enzyme elevations. Immunoallergic features (rash, fever, eosinophilia) were not present, but some patients had high levels of autoantibodies. Nevertheless, the liver injury resolved rapidly once noni was discontinued and other features of autoimmunity were not present.</p><p><a class="def" href="/books/n/livertox/glossary/def-item/glossary.likelihood-score/">Likelihood score</a>: C (probable rare cause of clinically apparent liver injury).</p></div><div id="Noni.Mechanism_of_Injury"><h3>Mechanism of Injury</h3><p>The mechanism of hepatotoxicity of noni is unknown. Extracts of the noni fruit have multiple components, including low levels of anthraquinones which are often cited as being hepatotoxic. However, the cases of noni associated liver injury have had all of the characteristics of idiosyncratic liver injury rather than direct toxicity, and in vitro and in vivo studies of noni have not demonstrated evidence of intrinsic hepatotoxicity.</p></div><div id="Noni.Outcome_and_Management"><h3>Outcome and Management</h3><p><a class="def" href="/books/n/livertox/glossary/def-item/glossary.hepatotoxicity/">Hepatotoxicity</a> attributed to noni juice has occasionally been severe and led to acute liver failure, which in at least one case necessitated emergency liver transplantation. <a class="def" href="/books/n/livertox/glossary/def-item/glossary.rechallenge/">Rechallenge</a> studies have not been reported.</p><p>Other Names: Morinda citrifolia, Indian mulberry, Ba Ji Tian, Cheese fruit, Tahitian Noni Juice®, Xeronine</p><p>Drug Class: <a href="/books/n/livertox/HerbalDietarySuppl/">Herbal and Dietary Supplements</a></p></div></div><div id="Noni.PRODUCT_INFORMATION"><h2 id="_Noni_PRODUCT_INFORMATION_">PRODUCT INFORMATION</h2><p>
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<b>REPRESENTATIVE TRADE NAMES</b>
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</p><p>Noni – Generic</p><p>
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<b>DRUG CLASS</b>
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</p><p>Herbal and <a class="def" href="/books/n/livertox/glossary/def-item/glossary.dietary-supplements/">Dietary Supplements</a></p><p>SUMMARY INFORMATION</p><p>
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<a href="https://www.nccih.nih.gov/health/noni" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Fact Sheet at National Center for Complementary and Integrative Health, NIH</a>
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</p></div><div id="Noni.CHEMICAL_FORMULA_AND_STRUCTURE"><h2 id="_Noni_CHEMICAL_FORMULA_AND_STRUCTURE_">CHEMICAL FORMULA AND STRUCTURE</h2><div id="Noni.Tc" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK548374/table/Noni.Tc/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Noni.Tc_lrgtbl__"><table><tbody><tr><th id="hd_b_Noni.Tc_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">DRUG</th><th id="hd_b_Noni.Tc_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CAS REGISTRY NUMBER</th><th id="hd_b_Noni.Tc_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MOLECULAR FORMULA</th><th id="hd_b_Noni.Tc_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">STRUCTURE</th></tr><tr><td headers="hd_b_Noni.Tc_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Noni</td><td headers="hd_b_Noni.Tc_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a href="https://pubchem.ncbi.nlm.nih.gov/substance/135352145" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem">84929-68-0</a>
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</td><td headers="hd_b_Noni.Tc_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Herbal mixture</td><td headers="hd_b_Noni.Tc_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not applicable</td></tr></tbody></table></div></div></div><div id="Noni.ANNOTATED_BIBLIOGRAPHY"><h2 id="_Noni_ANNOTATED_BIBLIOGRAPHY_">ANNOTATED BIBLIOGRAPHY</h2><p>References updated: 28 March 2020</p><ul class="first-line-outdent"><li><div class="bk_ref" id="Noni.REF.zimmerman.1999">Zimmerman HJ. Unconventional drugs. Miscellaneous drugs and diagnostic chemicals. In, Zimmerman, HJ. Hepatotoxicity: the adverse effects of drugs and other chemicals on the liver. 2nd ed. Philadelphia: Lippincott, 1999: pp. 731-4.<div><i>(Expert review of hepatotoxicity published in 1999; noni is not discussed).</i></div></div></li><li><div class="bk_ref" id="Noni.REF.seeff.2013">Seeff L, Stickel F, Navarro VJ. Hepatotoxicity of herbals and dietary supplements. In, Kaplowitz N, DeLeve LD, eds. Drug-induced liver disease. 3rd ed. Amsterdam: Elsevier, 2013, pp. 631-58.<div><i>(Review of hepatotoxicity of herbal and dietary supplements [HDS] mentions that noni juice has been implicated in cases of hepatitis and acute liver failure).</i></div></div></li><li><div class="bk_ref" id="Noni.REF3">Noni. In, PDR for Herbal Medicines. 4th ed. Montvale, New Jersey: Thomson Healthcare Inc. 2007, pp 604-5.<div><i>(Compilation of short monographs on herbal medications and dietary supplements).</i></div></div></li><li><div class="bk_ref" id="Noni.REF.wang.2002.1127">Wang MY, West BJ, Jensen CJ, Nowichi D, Su C, Palu AK, Anderson G. Morinda citrifolia(noni): a literature review and recent advances in Noni research. <span><span class="ref-journal">Acta Pharmacologica Sinica. </span>2002;<span class="ref-vol">23</span>:1127–41.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/12466051" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12466051</span></a>]<div>
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<i>(Extensive review of the literature on in vitro and in vivo effects of noni as well as studies in animals and humans which demonstrated lack of toxicity).</i>
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</div></div></li><li><div class="bk_ref" id="Noni.REF.pittler.2003.451">Pittler MH, Ernest E. Systematic review: hepatotoxic events associated with herbal medicinal products. <span><span class="ref-journal">Aliment Pharmacol Ther. </span>2003;<span class="ref-vol">18</span>:451–71.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/12950418" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12950418</span></a>]<div>
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<i>(Systematic review of published cases of hepatotoxicity due to herbal medications listing 52 case reports or case series; noni is not listed or mentioned).</i>
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</div></div></li><li><div class="bk_ref" id="Noni.REF.millonig.2005.445">Millonig G, Stadlmann S, Vogel W. Herbal hepatotoxicity: acute hepatitis caused by a Noni preparation(Morinda citrifolia). <span><span class="ref-journal">Eur J Gastroenterol Hepatol. </span>2005;<span class="ref-vol">17</span>:445–7.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/15756098" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15756098</span></a>]<div>
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<i>(45 year old man developed malaise and chest discomfort a few weeks after starting noni juice [bilirubin 0.8 mg/dL, ALT 1995 U/L, GGT 539 U/L], with resolution within 1 month of stopping).</i>
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</div></div></li><li><div class="bk_ref" id="Noni.REF.stadlbauer.2005.4758">Stadlbauer V, Fickert P, Lackner C, Schmerlaib J, Krisper P, Trauner M, Stauber RE. Hepatotoxicity of NONI juice: report of two cases. <span><span class="ref-journal">World J Gastroenterol. </span>2005;<span class="ref-vol">11</span>:4758–60.</span> [<a href="/pmc/articles/PMC4615426/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4615426</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/16094725" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16094725</span></a>]<div>
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<i>(2 cases from Austria: 29 year old man developed acute liver failure after taking 1.5 L of noni juice over 3 weeks and various Chinese herbs for 7 days [bilirubin 45.3 mg/dL, ALT 1626 U/L, INR 1.4], undergoing liver transplantation 6 days later; 62 year old woman developed vomiting and diarrhea 2 months after ingesting noni juice daily for 3 months [bilirubin 2.9 mg/dL, ALT 2381 U/L, Alk P 292 U/L], resolving over next 9 months).</i>
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</div></div></li><li><div class="bk_ref" id="Noni.REF.west.2006.3616">West BJ, Jensen CJ, Westendorf J. Noni juice is not hepatotoxic. <span><span class="ref-journal">World J Gastroenterol. </span>2006;<span class="ref-vol">12</span>:3616–9.</span> [<a href="/pmc/articles/PMC4087581/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4087581</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/16773722" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16773722</span></a>]<div>
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<i>(Letter in response to Millonig [2005] and Stadlbauer [2005] questioning the link of the liver injury to noni juice intake, and reviewing studies of safety of noni in animals and man which showed no evidence of direct hepatotoxicity).</i>
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</div></div></li><li><div class="bk_ref" id="Noni.REF.yuce.2006.167">Yuce B, Gulberg V, Diebold J, Gerbes AL. Hepatitis induced by Noni juice from Morinda citrifolia: a rare cause of hepatotoxicity or the tip of the iceberg? <span><span class="ref-journal">Digestion. </span>2006;<span class="ref-vol">73</span>:167–70.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/16837801" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16837801</span></a>]<div>
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<i>(24 year old woman with multiple sclerosis on beta interferon developed jaundice 4 weeks after starting noni juice [bilirubin 5.3 rising to 43.5 mg/dL, ALT 1538 to 3648 U/L, GGT 110 U/L], resolving in 4 weeks after stopping noni and 5 weeks after stopping beta interferon).</i>
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</div></div></li><li><div class="bk_ref" id="Noni.REF.west.2006.47">West BJ. Hepatotoxicity from interferon-beta, not noni juice. <span><span class="ref-journal">Digestion. </span>2006;<span class="ref-vol">74</span>:47–8.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/17068398" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17068398</span></a>]<div>
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<i>(Letter in response to Yuce [2006] suggesting that the liver injury was more likely due to beta interferon than noni).</i>
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</div></div></li><li><div class="bk_ref" id="Noni.REF.l_pezcepero_andrada.2007.179">López-Cepero Andrada JM, Lerma Castilla S, Fernández Olvera MD, Amaya Vidal A. <span><span class="ref-journal">Rev Esp Enferm Dig. </span>2007;<span class="ref-vol">99</span>:179–81.</span> [Hepatotoxicity caused by a Noni(Morinda citrifolia) preparation] Spanish. [<a href="https://pubmed.ncbi.nlm.nih.gov/17516838" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17516838</span></a>]<div>
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<i>(33 year old woman developed jaundice a few weeks after starting daily use of noni juice during travel to Ecuador [bilirubin 8.1 mg/dL, ALT 2740 U/L, Alk P 205 U/L, prothrombin 58%], resolving rapidly upon stopping the herbal).</i>
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</div></div></li><li><div class="bk_ref" id="Noni.REF.west.2007.737">West BJ, Berrio LF. <span><span class="ref-journal">Rev Esp Enferm Dig. </span>2007;<span class="ref-vol">99</span>:737–8.</span> [Tahitian Noni juice is not hepatotoxic] Spanish. [<a href="https://pubmed.ncbi.nlm.nih.gov/18290705" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18290705</span></a>]<div>
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<i>(Letter in response to Lopez-Cepero Andrada [2007] questioning the role of noni juice in the liver injury, because of the lack of anti-HEV testing and lack of verification of the purity and identity of noni in the product).</i>
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</div></div></li><li><div class="bk_ref" id="Noni.REF.potterat.2007.191">Potterat O, Hamburger M. Morinda citrifolia(Noni) fruit—phytochemistry, pharmacology, safety. <span><span class="ref-journal">Planta Med. </span>2007;<span class="ref-vol">73</span>:191–9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/17286240" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17286240</span></a>]<div>
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<i>(Review of the history, phytochemistry, pharmacology, animal and clinical studies and safety of noni; 4 case reports of hepatotoxicity have been reported, but review by the European Food Safety Authority “concluded that there was no convincing evidence for a causal relationship”).</i>
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</div></div></li><li><div class="bk_ref" id="Noni.REF.garc_acort_s.2008.688">García-Cortés M, Borraz Y, Lucena MI, Peláez G, Salmerón J, Diago M, Martínez-Sierra MC, et al. Liver injury induced by “natural remedies”: an analysis of cases submitted to the Spanish Liver Toxicity Registry. <span><span class="ref-journal">Rev Esp Enferm Dig. </span>2008;<span class="ref-vol">100</span>:688–95.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/19159172" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19159172</span></a>]<div>
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<i>(Among 521 cases of drug induced liver injury submitted to Spanish registry, 13 [2%] were due to herbals, but none were attributed to noni juice).</i>
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</div></div></li><li><div class="bk_ref" id="Noni.REF.stadlbauer.2008.2406">Stadlbauer V, Weiss S, Payer F, Stauber RE. Herbal does not at all mean innocuous: the sixth case of hepatotoxicity associated with morinda citrifolia(noni). <span><span class="ref-journal">Am J Gastroenterol. </span>2008;<span class="ref-vol">103</span>:2406–7.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/18844633" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18844633</span></a>]<div>
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<i>(43 year old man with glioblastoma developed elevated liver tests two weeks after starting noni juice [ALT rising from 34 to 516 U/L with normal bilirubin], resolving when noni juice was stopped).</i>
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</div></div></li><li><div class="bk_ref" id="Noni.REF.west.2009.581">West BJ, Su CX, Jensen CJ. Hepatotoxicity and subchronic toxicity tests of Morinda citrifolia(noni) fruit. <span><span class="ref-journal">J Toxicol Sci. </span>2009;<span class="ref-vol">34</span>:581–5.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/19797868" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19797868</span></a>]<div>
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<i>(Noni extract was prepared from Tahitian noni fruits and tested for hepatotoxicity in vitro and in vivo; no toxicity found towards HepG2 cells or laboratory rats given a range of doses orally for up to 90 days).</i>
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</div></div></li><li><div class="bk_ref" id="Noni.REF.jacobsson.2009.1039">Jacobsson I, Jönsson AK, Gerdén B, Hägg S. Spontaneously reported adverse reactions in association with complementary and alternative medicine substances in Sweden. <span><span class="ref-journal">Pharmacoepidemiol Drug Saf. </span>2009;<span class="ref-vol">18</span>:1039–47.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/19650152" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19650152</span></a>]<div>
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<i>(Review of 778 spontaneous reports of adverse reactions to herbals to Swedish Registry; noni juice not mentioned).</i>
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</div></div></li><li><div class="bk_ref" id="Noni.REF.reuben.2010.2065">Reuben A, Koch DG, Lee WM., Acute Liver Failure Study Group. Drug-induced acute liver failure: results of a U.S. multicenter, prospective study. <span><span class="ref-journal">Hepatology. </span>2010;<span class="ref-vol">52</span>:2065–76.</span> [<a href="/pmc/articles/PMC3992250/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3992250</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20949552" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20949552</span></a>]<div>
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<i>(Among 1198 patients with acute liver failure enrolled in a US prospective study between 1998 and 2007, 133 [11%] were attributed to drug induced liver injury of which 12 [9%] were due to herbals, but none were attributed to noni juice).</i>
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</div></div></li><li><div class="bk_ref" id="Noni.REF.stickel.2011.595">Stickel F, Kessebohm K, Weimann R, Seitz HK. Review of liver injury associated with dietary supplements. <span><span class="ref-journal">Liver Int. </span>2011;<span class="ref-vol">31</span>:595–605.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/21457433" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21457433</span></a>]<div>
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<i>(Review of current understanding of liver injury from herbals and dietary supplements focusing upon Herbalife and Hydroxycut products, green tea, usnic acid, Noni juice, Chinese herbs, vitamin A and anabolic steroids).</i>
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</div></div></li><li><div class="bk_ref" id="Noni.REF.yu.2011.222">Yu EL, Sivagnanam M, Ellis L, Huang JS. Acute hepatotoxicity after ingestion of Morinda citrifolia (Noni Berry) juice in a 14-year-old boy. <span><span class="ref-journal">J Pediatr Gastroenterol Nutr. </span>2011;<span class="ref-vol">52</span>:222–4.</span> [<a href="/pmc/articles/PMC5728648/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5728648</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21119544" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21119544</span></a>]<div>
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<i>(14 year old boy developed jaundice after having ingested 10 bottles of an antioxidant drink [containing green tea, aloe vera and noni] over the previous 2 months [bilirubin 4.4 rising to 12.3 mg/dL, ALT 2860 U/L, GGT 141 U/L, INR 1.7], resolving in 2 months).</i>
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</div></div></li><li><div class="bk_ref" id="Noni.REF.jim_nezencarnaci_n.2012">Jiménez-Encarnación E, Ríos G, Muñoz-Mirabal A, Vilá LM. Euforia-induced acute hepatitis in a patient with scleroderma. BMJ Case Rep 2012; 2012. [<a href="/pmc/articles/PMC4544356/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4544356</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23257938" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23257938</span></a>]<div><i>(45 year old woman with systemic sclerosis developed jaundice 1 month after starting Euphoria, a combination herbal product whose ingredients included aloe vera, resveratrol, green tea, noni and several berries [bilirubin 17.7 mg/dL, ALT 837 U/L, Alk P 134 U/L], with slow recovery over the 18 months after stopping).</i></div></div></li><li><div class="bk_ref" id="Noni.REF.teschke.2012.1543">Teschke R, Wolff A, Frenzel C, Schulze J, Eickhoff A. Herbal hepatotoxicity: a tabular compilation of reported cases. <span><span class="ref-journal">Liver Int. </span>2012;<span class="ref-vol">32</span>:1543–56.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/22928722" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22928722</span></a>]<div>
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<i>(A systematic compilation of all publications on the hepatotoxicity of specific herbals identified 185 publications on 60 different herbs, herbal drugs and supplements including 6 publications on noni).</i>
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</div></div></li><li><div class="bk_ref" id="Noni.REF.teschke.2013.1093">Teschke R, Schulze J, Schwarzenboeck A, Eickhoff A, Frenzel C. Herbal hepatotoxicity: suspected cases assessed for alternative causes. <span><span class="ref-journal">Eur J Gastroenterol Hepatol. </span>2013;<span class="ref-vol">25</span>:1093–8.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/23510966" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23510966</span></a>]<div>
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<i>(Review of 23 publications of case series of liver injury attributed to herbals or dietary supplements found alternative causes to be "evident" in 49% of 573 cases).</i>
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</div></div></li><li><div class="bk_ref" id="Noni.REF.bunchorntavakul.2013.3">Bunchorntavakul C, Reddy KR. Review article: herbal and dietary supplement hepatotoxicity. <span><span class="ref-journal">Aliment Pharmacol Ther. </span>2013;<span class="ref-vol">37</span>:3–17.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/23121117" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23121117</span></a>]<div>
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<i>(Systematic review of literature on HDS associated liver injury mentions that noni has been associated with clinically apparent hepatotoxicity).</i>
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</div></div></li><li><div class="bk_ref" id="Noni.REF.mrzljak.2013.19">Mrzljak A, Kosuta I, Skrtic A, Kanizaj TF, Vrhovac R. Drug-Induced Liver Injury Associated with Noni (Morinda citrifolia) Juice and Phenobarbital. <span><span class="ref-journal">Case Rep Gastroenterol. </span>2013;<span class="ref-vol">7</span>:19–24.</span> [<a href="/pmc/articles/PMC3573787/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3573787</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23467452" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23467452</span></a>]<div>
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<i>(38 year old woman on phenobarbital for 9 months developed jaundice one week after starting noni juice [60 mL daily] [bilirubin 9.7 mg/dL, ALT 813 U/L, Alk P 532 U/L, INR 2.6], resolving within 6 months of stopping both noni and phenobarbital and with corticosteroid therapy).</i>
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</div></div></li><li><div class="bk_ref" id="Noni.REF.bj_rnsson.2013.1419">Björnsson ES, Bergmann OM, Björnsson HK, Kvaran RB, Olafsson S. Incidence, presentation and outcomes in patients with drug-induced liver injury in the general population of Iceland. <span><span class="ref-journal">Gastroenterology. </span>2013;<span class="ref-vol">144</span>:1419–25.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/23419359" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23419359</span></a>]<div>
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<i>(In a population based study of drug induced liver injury from Iceland, 96 cases were identified over a 2 year period, including 15 [16%] due to herbal and dietary supplements, none of which were attributed to noni juice).</i>
|
||
</div></div></li><li><div class="bk_ref" id="Noni.REF.navarro.2013.715">Navarro VJ, Seeff LB. Liver injury induced by herbal complementary and alternative medicine. <span><span class="ref-journal">Clin Liver Dis. </span>2013;<span class="ref-vol">17</span>:715–35.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/24099027" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24099027</span></a>]<div>
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||
<i>(Review of HDS induced liver injury including regulatory problems, difficulties in diagnosis and causality assessment; mentions that noni has been linked to cases of hepatitis but none were fatal).</i>
|
||
</div></div></li><li><div class="bk_ref" id="Noni.REF.navarro.2014.1399">Navarro VJ, Barnhart H, Bonkovsky HL, Davern T, Fontana RJ, Grant L, Reddy KR, et al. Liver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network. <span><span class="ref-journal">Hepatology. </span>2014;<span class="ref-vol">60</span>:1399–408.</span> [<a href="/pmc/articles/PMC4293199/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4293199</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25043597" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25043597</span></a>]<div>
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||
<i>(Among 85 cases of HDS associated liver injury [not due to anabolic steroids] enrolled in a US prospective study between 2004 and 2013, noni juice was not implicated in any of the cases).</i>
|
||
</div></div></li><li><div class="bk_ref" id="Noni.REF.seeff.2015.517">Seeff LB, Bonkovsky HL, Navarro VJ, Wang G. Herbal products and the liver: a review of adverse effects and mechanisms. <span><span class="ref-journal">Gastroenterology. </span>2015;<span class="ref-vol">148</span>:517–32.e3.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/25500423" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25500423</span></a>]<div>
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||
<i>(Extensive review of possible beneficial as well as harmful effects of herbal products on the liver in a supplemental table lists noni as having been implicated in cases of severe acute hepatitis).</i>
|
||
</div></div></li><li><div class="bk_ref" id="Noni.REF.chalasani.2015.1340">Chalasani N, Bonkovsky HL, Fontana R, Lee W, Stolz A, Talwalkar J, Reddy KR, et al. United States Drug Induced Liver Injury Network. Features and outcomes of 899 patients with drug-induced liver injury: The DILIN Prospective Study. <span><span class="ref-journal">Gastroenterology. </span>2015;<span class="ref-vol">148</span>:1340–52.e7.</span> [<a href="/pmc/articles/PMC4446235/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4446235</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25754159" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25754159</span></a>]<div>
|
||
<i>(Among 899 cases of drug induced liver injury enrolled in a prospective database between 2004 and 2012, HDS were implicated in 145 [16%], none of which were attributed to noni [Navarro et al Hepatology 2014]).</i>
|
||
</div></div></li><li><div class="bk_ref" id="Noni.REF.garridogallego.2015.247">Garrido-Gallego F, Muñoz-Gómez R, Muñoz-Codoceo C, Delgado-Álvarez P, Fernández-Vázquez I, Castellano G. Acute liver failure in a patient consuming Herbalife products and Noni juice. <span><span class="ref-journal">Rev Esp Enferm Dig. </span>2015;<span class="ref-vol">107</span>:247–8.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/25824932" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25824932</span></a>]<div>
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||
<i>(56 year old woman developed jaundice while taking several Herbalife products and noni juice [bilirubin 21.5 mg/dL, ALT 940 U/L, Alk P 187 U/L, INR 2.03], with progressive liver failure and successful liver transplantation 4 weeks after presentation).</i>
|
||
</div></div></li><li><div class="bk_ref" id="Noni.REF.garc_acort_s.2016.537">García-Cortés M, Robles-Díaz M, Ortega-Alonso A, Medina-Caliz I, Andrade RJ. Hepatotoxicity by dietary supplements: A tabular listing and clinical characteristics. <span><span class="ref-journal">Int J Mol Sci. </span>2016;<span class="ref-vol">17</span>:537.</span> [<a href="/pmc/articles/PMC4848993/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4848993</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27070596" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27070596</span></a>]<div>
|
||
<i>(Listing of published cases of liver injury from HDS products, but does not list those attributed to noni).</i>
|
||
</div></div></li><li><div class="bk_ref" id="Noni.REF.brown.2017">Brown AC. Liver toxicity related to herbs and dietary supplements: Online table of case reports. Part 2 of 5 series. Food Chem Toxicol 2017; 107 (Pt A): 472-501. [<a href="https://pubmed.ncbi.nlm.nih.gov/27402097" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27402097</span></a>]<div><i>(Description of an online compendium of cases of liver toxicity attributed to HDS products, lists at least 8 reports of liver injury for which there was exposure to noni; however, many had other possible causes).</i></div></div></li><li><div class="bk_ref" id="Noni.REF.vega.2017.783">Vega M, Verma M, Beswick D, Bey S, Hossack J, Merriman N, Shah A, et al. Drug Induced Liver Injury Network (DILIN). The incidence of drug- and herbal and dietary supplement-induced liver injury: preliminary findings from gastroenterologist-based surveillance in the population of the State of Delaware. <span><span class="ref-journal">Drug Saf. </span>2017;<span class="ref-vol">40</span>:783–7.</span> [<a href="/pmc/articles/PMC5699929/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5699929</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28555362" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28555362</span></a>]<div>
|
||
<i>(A prospective, population based registry of cases of drug induced liver injury occurring in Delaware during 2014, identified 20 cases [2.7 per 100,000] overall, including 6 due to HDS products, all of which were proprietary multiingredient products, none specifically listing noni as a component).</i>
|
||
</div></div></li><li><div class="bk_ref" id="Noni.REF.waldman.2013.690">Waldman W, Piotrowicz G, Sein Anand J. <span><span class="ref-journal">Przegl Lek. </span>2013;<span class="ref-vol">70</span>:690–2.</span> [Hepatoxic effect of a noni juice consumption--a case report] [<a href="https://pubmed.ncbi.nlm.nih.gov/24466723" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24466723</span></a>]<div>
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<i>(Ordered).</i>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK548374/?report=reader">PubReader</a></li><li><a href="/books/NBK548374/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK548374" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK548374" style="display:none" title="Cite this Page"><div class="bk_tt">LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. 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<a href="https://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=pubmed&pubmedfilters=true&term=Noni+AND+Human%5BMH%5D+AND+(drug+induced+liver+injury+OR+jaundice/CI+OR+bile+duct+diseases/CI+OR+liver/DE+OR+liver+diseases/CI)+AND+(%221900/1/1%22%5BEDat%5D:%222999/12/31%22%5BEDat%5D)" ref="pagearea=document-links&targetsite=external&targetcat=link&targettype=uri">Recent References on Noni: from PubMed.gov</a>
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<a href="https://clinicaltrials.gov/ct2/results?term=Noni" ref="pagearea=document-links&targetsite=external&targetcat=link&targettype=uri">Trials on Noni: from ClinicalTrials.gov</a>
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Epub 2012 Feb 17.</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/27190827" ref="ordinalpos=1&linkpos=3&log$=relatedarticles&logdbfrom=pubmed">Effect of Morinda citrifolia (Noni) Fruit Juice on High Fat Diet Induced Dyslipidemia in Rats.</a><span class="source">[J Clin Diagn Res. 2016]</span><div class="brieflinkpop offscreen_noflow">Effect of Morinda citrifolia (Noni) Fruit Juice on High Fat Diet Induced Dyslipidemia in Rats.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Shoeb A, Alwar MC, Shenoy PJ, Gokul P. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">J Clin Diagn Res. 2016 Apr; 10(4):FF06-10. Epub 2016 Apr 1.</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/27451258" ref="ordinalpos=1&linkpos=4&log$=relatedarticles&logdbfrom=pubmed">Pulmonary anti-inflammatory effects and spasmolytic properties of Costa Rican noni juice (Morinda citrifolia L.).</a><span class="source">[J Ethnopharmacol. 2016]</span><div class="brieflinkpop offscreen_noflow">Pulmonary anti-inflammatory effects and spasmolytic properties of Costa Rican noni juice (Morinda citrifolia L.).<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Dussossoy E, Bichon F, Bony E, Portet K, Brat P, Vaillant F, Michel A, Poucheret P. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">J Ethnopharmacol. 2016 Nov 4; 192:264-272. 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<div class="col-lg-3 col-12 centered-lg">
|
||
<p><a class="supportLink text-white" href="https://support.nlm.nih.gov/">Help</a><br />
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<a href="https://www.nlm.nih.gov/accessibility.html" class="text-white">Accessibility</a><br />
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<a href="https://www.nlm.nih.gov/careers/careers.html" class="text-white">Careers</a></p>
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<nav class="bottom-links">
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<ul class="mt-3">
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<li>
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<a class="text-white" href="//www.nlm.nih.gov/">NLM</a>
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</li>
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<li>
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<a class="text-white" href="https://www.nih.gov/">NIH</a>
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</li>
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<li>
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<a class="text-white" href="https://www.hhs.gov/">HHS</a>
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</li>
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<li>
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<a class="text-white" href="https://www.usa.gov/">USA.gov</a>
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<script type="text/javascript" src="/portal/portal3rc.fcgi/rlib/js/InstrumentOmnitureBaseJS/InstrumentNCBIConfigJS/InstrumentNCBIBaseJS/InstrumentPageStarterJS.js?v=1"> </script>
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<script type="text/javascript" src="/portal/portal3rc.fcgi/static/js/hfjs2.js"> </script>
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<noscript><img alt="statistics" src="/stat?jsdisabled=true&ncbi_db=books&ncbi_pdid=book-part&ncbi_acc=NBK548374&ncbi_domain=livertox&ncbi_report=record&ncbi_type=fulltext&ncbi_objectid=&ncbi_pcid=/NBK548374/&ncbi_pagename=Noni - LiverTox - NCBI Bookshelf&ncbi_bookparttype=chapter&ncbi_app=bookshelf" /></noscript>
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