{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T20:57:44Z","timestamp":1760821064140,"version":"3.40.5"},"reference-count":31,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2019,4,22]],"date-time":"2019-04-22T00:00:00Z","timestamp":1555891200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009663","name":"University Health Network","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009663","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background &amp; Aims<\/jats:title><jats:p>The use of complementary and alternative medicine (CAM) in patients with chronic hepatitis B (CHB) can interact with antiviral treatment or influence health\u2010seeking behaviour. We aimed to study the use of individual CAM modalities in CHB and explore determinants of use, particularly migration\u2010related, socio\u2010economic and clinical factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 436 CHB outpatients who attended the Toronto Centre for Liver Disease in 2015\u20102016 were included in this cross\u2010sectional study. Using the comprehensive I\u2010CAM questionnaire and health records, data were collected on socio\u2010demographic and clinical variables and on usage of 16 CAM modalities in the last year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixty percent of patients were male, 74% were Asian and 46% were using antiviral treatment. Three\u2010hundred and nine (71%) patients used CAM. Vitamin\/mineral preparations (45% of patients) were most commonly used. Overall CAM use and the specific use of potentially injurious CAM, such as green tea extract (9.2%) and St. John's wort (0.2%), were not associated with liver disease severity. Female sex, family history of CHB, lower serum HBV DNA, and higher socio\u2010economic status were independently associated with bio\u2010holistic CAM use, the clinically most\u2010relevant CAM group (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.05); ethnicity, antiviral therapy use and liver disease severity were not.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>CAM use among CHB patients was extensive, especially use of vitamin and mineral preparations, but without direct influence on liver disease severity. Bio\u2010holistic CAM use appeared to be associated with socio\u2010economic status rather than with ethnicity or liver disease severity. Despite the rare use of hepatotoxins, physicians should actively inquire about it.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.14105","type":"journal-article","created":{"date-parts":[[2019,3,26]],"date-time":"2019-03-26T06:57:00Z","timestamp":1553583420000},"page":"1418-1427","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Prevalence and predictors of complementary and alternative medicine modalities in patients with chronic hepatitis B"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3585-2778","authenticated-orcid":false,"given":"Kin Seng","family":"Liem","sequence":"first","affiliation":[{"name":"Toronto Centre for Liver Disease Toronto General Hospital, University Health Network Toronto Canada"},{"name":"Department of Gastroenterology and Hepatology Erasmus University Medical Center Rotterdam Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colina","family":"Yim","sequence":"additional","affiliation":[{"name":"Toronto Centre for Liver Disease Toronto General Hospital, University Health Network Toronto Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas D.","family":"Ying","sequence":"additional","affiliation":[{"name":"Toronto Centre for Liver Disease Toronto General Hospital, University Health Network Toronto Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wayel R.","family":"Zanjir","sequence":"additional","affiliation":[{"name":"Toronto Centre for Liver Disease Toronto General Hospital, University Health Network Toronto Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott","family":"Fung","sequence":"additional","affiliation":[{"name":"Toronto Centre for Liver Disease Toronto General Hospital, University Health Network Toronto Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David K.","family":"Wong","sequence":"additional","affiliation":[{"name":"Toronto Centre for Liver Disease Toronto General Hospital, University Health Network Toronto Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hemant","family":"Shah","sequence":"additional","affiliation":[{"name":"Toronto Centre for Liver Disease Toronto General Hospital, University Health Network Toronto Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2640-2211","authenticated-orcid":false,"given":"Jordan J.","family":"Feld","sequence":"additional","affiliation":[{"name":"Toronto Centre for Liver Disease Toronto General Hospital, University Health Network Toronto Canada"},{"name":"McLaughlin\u2010Rotman Centre for Global Health Toronto Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bettina E.","family":"Hansen","sequence":"additional","affiliation":[{"name":"Toronto Centre for Liver Disease Toronto General Hospital, University Health Network Toronto Canada"},{"name":"Institute of Health Policy, Management and Evaluation University of Toronto Toronto Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harry L. 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