Effectiveness of Hibiscus sabdariffa Linn for Obesity Treatment: A Systematic Review of Randomized Controlled Trials
Abstract
Background: Hibiscus sabdariffa Linn. (H. sabdariffa), commonly known as Rosella plants in Indonesia, has had various uses in the food and beverage industry and traditional medicines for hundreds of years. The main compounds of H. sabdariffa have been stated to have anti-obesity effects through its biologically active compounds. This review systematically evaluates the evidence from human randomized clinical trials on the effects of H. sabdariffa extract in obesity, including decreased bodyweight, normalizing the blood lipid profile, and modulating appetite-related biomarkers.
Subjects and Method: This review is based on the patient, intervention, comparison, and outcome (PICO) procedure, with the patient is people with obesity, the intervention is the administration of H. sabdariffa extract compared to control that given placebo, and the outcomes are reduced body weight and fat accumulation, normalize blood lipid profiles, and regulate biomarkers related to appetite. Articles used are limited to the publication year between 2013 and 2021. Search is done through PubMed, ScienceDirect, Wiley Online Library, Scopus, and Google Scholar with the keywords “hibiscus sabdariffa and obesity”, “hibiscus sabdariffa and lipogenesis”, “hibiscus sabdariffa and energy metabolism”, and “hibiscus sabdariffa and appetite”.
Results: The search resulted in 10 studies involving 453 subjects. We proved several significant effects of H. sabdariffa extract on obese subjects. Administration of H. sabdariffa extract for several doses and several days can improve anthropometry measurement, fat accumulation, increased satiety sensation, while the appetite sensation mainly for fatty, sweet, and salty foods was decreased.
Conclusion: This review suggests that the benefit of H. sabdariffa to people with obesity are associated with body weight and blood lipid profile-lowering effect; however, more high-quality clinical trials are needed.
Keywords: Hibiscus sabdariffa, obesity, appetite
Correspondence: Suci Anggraini, Masters Program in Biomedical Science, Faculty of Medicine, Universitas Indonesia. Jl. Salemba Raya 4, Jakarta Pusat, DKI Jakarta 10430. Email: suci.angraini@ui.ac.id . Mobile: 081363397973.
Indonesian Journal of Medicine (2021), 06(04): 439-451
https://doi.org/10.26911/theijmed.2021.06.04.10
References
">AbAboonabi A, Aboonabi A. (2020). Anthocyanins reduce inflammation and improve glucose and lipid metabolism associated with inhibiting nuclear factorkappaB activation and increasing PPARγ gene expression in metabolic syndrome subjects. Free Radic Bio and Med. 150:309. doi:10.1016/j.freeradbiomed.2020.02.004.
Abubakar SM, Ukeyima MT, Spencer JPE, Lovegrove JA. (2019). Acute effects of hibiscus sabdariffa calyces on postprandial blood pressure, vascular function, blood lipids, biomarkers of insulin resistance and inflammation in humans. Nutrients. 11(2):341. doi:10.3390/nu11020341.
AguirreGarcía F, YáñezLópez L, Armella MA, Verde JR. (2019). Studies from Hibiscus sabdariffa (Hibiscus) Plant for Blood Cholesterol Levels Reduction. Am J Plant Sci. 10(4). doi:10.4236/ajps.2019.104036.
AlarconAguilar FJ, Zamilpa A, PerezGarcia MD, AlmanzaPerez .C, RomeroNuñez E, CamposSepulveda EA, VazquezCarrillo LI, et al. (2007). Effect of Hibiscus sabdariffa on obesity in MSG mice. J Ethnopharmacol. 114(1):6671. doi:10.1016/j.jep.2007.07.020.
American Diabetes Association. (2018). Standard medical care in diabetes 2018. Clin Diabetes. 36(1):1437. doi:10.2337/cd170119.
Annamalai S, Mohanam L, Alwin D, Prabhu V. (2016). Effect of combination therapy of melatonin and orlistat on high fat diet induced changes in lipid profiles and liver function parameters in serum of rats. Obes. 2:415. doi:10.1016/j.obmed.2016.05.003.
Asgary S, Soltani R, Zolghadr M, Keshvari M, Sarrafzadegan N. (2016). Evaluation of the effects of roselle (Hibiscus sabdariffa L.) on oxidative stress and serum levels of lipids, insulin and hsCRP in adult patients with metabolic syndrome: A doubleblind placebocontrolled clinical trial. J Complement Integr Med. 13(2):17580. doi:10.1515/jcim20150030
BoixCastejón M, HerranzLópez M, Pérez Gago A, OlivaresVicente M, Caturla N, Roche E, Micol V. (2018). Hibiscus and lemon verbena polyphenols modulate appetiterelated biomarkers in overweight subjects: A randomized controlled trial. Food Funct. 9(6):317384. doi:10.1039/c8fo00367j.
BorrásLinares I, FernándezArroyo S, ArráezRoman D, PalmerosSuárez, PA, Del ValDíaz R, AndradeGonzáles I, FernándezGutiérrez A, et al. (2015). Characterization of phenolic compounds, anthocyanidin, antioxidant and antimicrobial activity of 25 varieties of Mexican Roselle (Hibiscus sabdariffa). Ind Crops Prod. 69:38594. doi:10.1016/j.indcrop.2015.02.053.
Bule M, Albelbeisi AH, Nikfar S, Amini M, Abdollahi M. (2020). The antidiabetic and antilipidemic effects of Hibiscus sabdariffa: A systematic review and metaanalysis of randomized clinical trials. Food Res Int. 130:108980. doi:10.1016/j.foodres.2020.108980.
Chang HC, Peng CH, Yeh DM, Kao ES, Wang CJ. (2014). Hibiscus sabdariffa extract inhibits obesity and fat accumulation, and improves liver steatosis in humans. Food Funct. 5(4):7349. doi:10.1039/c3fo60495k.
DiezEchave P, Vezza T, RodríguezNogales A, RuizMalagón AJ, HidalgoGarcía L, GarridoMesa J, MolinaTijeras JA, et al. (2020). The prebiotic properties of Hibiscus sabdariffa extract contribute to the beneficial effects in dietinduced obesity in mice. Food Res Int. 127: 108722. doi:10.1016/j.foodres.2019.108722.
Hajifaraji M, Matlabi M, AhmadzadehSani F, Mehrabi Y, Rezaee MS, Hajimehdipour H, Hasanzadeh A, et al. (2018). Effects of aqueous extracts of dried calyx of sour tea (Hibiscus sabdariffa L.) on polygenic dyslipidemia: A randomized clinical trial. Avicenna J Phytomed. 8(1):2432. doi:10.22038/ajp.2017.17692.1684
Hayamizu K, Ishii Y, Kaneko I, Shen M, Okuhara Y, Shigematsu N, Tomi H, et al. (2003). Effects of Garcinia cambogia (Hydroxycitric Acid) on visceral fat accumulation: A doubleblind, randomized, placebocontrolled trial. Curr Ther Res Clin Exp. 64(8):55167. doi: 10.1016/j.curtheres.2003.08.006
HerranzLópez M, BarrajónCatalán E, SeguraCarretero A, Menéndez JA, Joven J, Micol V (2015). Lemon verbena (Lippia citriodora) polyphenols alleviate obesityrelated disturbances in hypertrophic adipocytes through AMPKdependent mechanisms. Phytomedicine. 22(6):60514. doi:10.1016/j.phymed.2015.03.015.
HerranzLópez M, OlivaresVicente M, BoixCastejón M, Caturla N, Roche E, Micol, V. (2019). Differential effects of a combination of Hibiscus sabdariffa and Lippia citriodora polyphenols in overweight/obese subjects: A randomized controlled trial. Sci Rep. 9(2999). doi:10.1038/s41598019391595.
Hirunpanich V, Utaipat A, Morales NP, Bunyapraphatsara N, Sato H, Herunsale A, Suthisisang C. (2006). Hypocholesterolemic and antioxidant effects of aqueous extracts from the dried calyx of Hibiscus sabdariffa L. in hypercholesterolemic rats. J Ethnopharmacol. 103(2):252260. doi:10.1016/j.jep.2005.08.033.
Hsu CL, Yen GC. (2007). Effects of flavonoids and phenolic acids on the inhibition of adipogenesis in 3T3L1 adipocytes. J Agric Food Chem. 55(21):840410. doi:10.1021/jf071695r
Jabeur I, Pereira E, Barros L, Calhelha RC, Soković M, Oliveira MBPP, Ferreira ICFR. (2017). Hibiscus sabdariffa L. as a source of nutrients, bioactive compounds and colouring agents. Food Res Int. 100(Pt 1):71723. doi:10.1016/j.foodres.2017.07.073
Janani C, Ranjitha Kumari BD. (2015). PPAR gamma gene A review. Diabetes Metab Syndr. 9(1):4650. doi:10.1016/j.dsx.2014.09.015
Kartinah NT, Komara N, Noviati ND, Dewi S, Yolanda S, Radhina A, Heriyanto H, Sianipar IR. (2021). Potential of Hibiscus sabdariffa Linn. in managing FGF21 resistance in diet‐induced‐ obesity rats via miR‐34a regulation. Vet Med. 8:30917. doi:10.1002/vms3.653.
Kartinah NT, Komara NK, Sianipar IR, Noviati ND. (2019). The Potential of Hibiscus sabdariffa Linn. for Treatment of Obesity: Focus on FGF21 in Liver and Adipose Tissue. eJournal Kedokteran Indonesia. 7(2). doi:10.23886/ejki.7.11093
Liu Y, Sun M, Yao H, Liu Y, Gao R. (2017). Herbal Medicine for the Treatment of Obesity: An Overview of Scientific Evidence from 2007 to 2017. Evid Based Complement Alternat Med. 2017:8943059. doi:10.1155/2017/8943059
Lutz TA. (2016). Gut hormones such as amylin and GLP1 in the control of eating and energy expenditure. Int J Obes Supp. 6:S1521. doi:10.1038/ijosup.2016.4
Marhuenda J, Perez S, VictoriaMontesinos D, Abellán MS, Caturla N, Jones J, LópezRomán J. (2020). A randomized, doubleblind, placebo controlled trial to determine the effectiveness a polyphenolic extract (Hibiscus sabdariffa and lippia citriodora) in the reduction of body fat mass in healthy subjects. Foods. 9(1):55. doi:10.3390/foods9010055
Ojulari OV, Lee SG, Nam JO (2019). Beneficial effects of natural bioactive compounds from hibiscus sabdariffa l. on obesity. Molecules. 24(1):210. doi:10.3390/molecules24010210
Riset Kesehatan Dasar (RISKESDAS). (2019). Laporan Nasional Riskesdas 2018. Badan Penelitian dan Pengembangan Kesehatan Riset.
Sabzghabaee A, Ataei E, Kelishadi R, Ghannadi A, Soltani R, Badri S, Shirani S. (2013). Effect of hibiscus sabdariffa calices on dyslipidemia in obese adolescents: A triplemasked randomized controlled trial. Mater Sociomed. 25 (2): 769. doi:10.5455/msm.2013.25.7679.
Serban C, Sahebkar A, Ursoniu S, Andrica F, Banach M. (2015). Effect of sour tea (Hibiscus sabdariffa L.) on arterial hypertension: A systematic review and metaanalysis of randomized controlled trials. J Hypertens. 33(6):111927. doi:10.1097/HJH.0000000000000585.
Sern A, Marhuenda J, Arcusa R, PérezPiñero S, SánchezMacarro M, GarcíaMuñoz AM, VictoriaMontesinos D, et al. (2021). Effectiveness of a polyphenolic extract (Lippia citriodora and Hibiscus sabdariffa) on appetite regulation in overweight and obese grade I population: an 8week randomized, doubleblind, crossover, placebocontrolled trial. Eur J Nutr. 61(2):82541. doi:10.1007/s0039402102678x
Stuby J, Gravestock I, Wolfram E, Pichierri G, Steurer J, Burgstaller JM. (2019). Appetitesuppressing and satietyincreasing bioactive phytochemicals: A systematic review. Nutrients. 11(9):2238. doi:10.3390/nu11092238
Timper K, Brüning JC. (2017). Hypothalamic circuits regulating appetite and energy homeostasis: Pathways to obesity. Dis Model Mech. 10(6)67989. doi:10.1242/dmm.026609
Ural C, Belli H, Akbudak M, Solmaz A, Bektas ZD, Celebi F. (2017). Relation of binge eating disorder with impulsiveness in obese individuals. World J Psychiatry. 7(2):11420. doi:10.5498/wjp.v7.i2.114
Wansink B, Sobal J (2007). Mindless eating: The 200 daily food decisions we overlook. Environ Behav. 39(1):10623. doi: 10.1177/0013916506295573
