Context Hibiscus sabdariffa (hibiscus) has been proposed to affect cardiovascular risk factors. Objective To review the evidence for the effectiveness of hibiscus in modulating cardiovascular disease risk markers, compared with pharmacologic, nutritional, or placebo treatments. Data Sources A systematic search of the Web of Science, Cochrane, Ovid (MEDLINE, Embase, AMED), and Scopus databases identified reports published up to June 2021 on randomized controlled trials using hibiscus as an intervention for lipid profiles, blood pressure (BP), and fasting plasma glucose levels in adult populations. Data Extraction Seventeen chronic trials were included. Quantitative data were examined using a random effects meta-analysis and meta-regression with trial sequential analysis to account for type I and type II errors. Data Analysis Hibiscus exerted stronger effects on systolic BP (−7.10 mmHg [95%CI, −13.00, −1.20]; I2 = 95%; P = 0.02) than placebo, with the magnitude of reduction greatest in those with elevated BP at baseline. Hibiscus induced reductions to BP similar to that resulting from medication (systolic BP reduction, 2.13 mmHg [95%CI, −2.81, 7.06], I2 = 91%, P = 0.40; diastolic BP reduction, 1.10 mmHg [95%CI, −1.55, 3.74], I2 = 91%, P = 0.42). Hibiscus also significantly lowered levels of low-density lipoprotein compared with other teas and placebo (−6.76 mg/dL [95%CI, −13.45, −0.07]; I2 = 64%; P = 0.05). Conclusions Regular consumption of hibiscus could confer reduced cardiovascular disease risk. More studies are warranted to establish an effective dose response and treatment duration. Systematic Review Registration PROSPERO registration no. CRD42020167295

Abstract190 children aged 7-18 years from an endemic fluorotic village “Talab Sarai (n = 130) and a non-fluorotic, control, village “Ottawa” (n = 60) were selected for comparison. Children were examined for fluoride (F-) concentration in drinking water, urine, and serum as well as Dental fluorosis (DF) and thyroid hormone levels. The mean concentration of water fluoride (WF) in the sample group was 6.23 mg/L, urine fluoride (UF) 3.38 mg/L, and serum fluoride (SF) 0.21 mg/L, while DF was 93.07%. Significant elevations (P = 0.000) in the concentration of all these four variables were observed in sample group children as compared to control. Mean Free Tetra-iodothyronine (FT4), Free Tri-iodothyronine (FT3) and Thyroid Stimulating Hormone (TSH) concentrations in the sample group were 16.64pmol/L, 5.57 pmol /L and 4.41 mlU/L, respectively. No marked difference in FT4 (P = 0.1) was noted, while significant elevations in FT3 and TSH (P = 0.000) were found in the sample relative to the control group. 80% of the children displayed clear thyroid hormonal derangements, with 36.92% having high TSH and 43.07% with FT3 and FT4 disorders. A moderate to strong correlation among WF, UF, SF and DF (r = 0.94, 0.60, 0.60, 0.72) and a very strong correlation between WF and TSH (r = 0.9) were observed. Our results suggest that excess F- level that is four times greater than the “safe limit” is not only increasing fluoride concentration in body fluids but is also affecting thyroid hormones in 4 out of 5 children which could lead to abnormal physical and mental growth in later developmental stages.

In the present study 134 children were studied for comparison and correlation between an endemic fluorotic village Rukh Mudke (RM), n = 74, and a non-fluorotic village Ottawa (OTW), n = 60. The children were aged between 7-18 years and selected for the estimation of fluoride in their household water, body fluids (urine-serum), dental fluorosis and thyroid hormones (Free tri-iodothyronine (FT3) free tetra iodothyronine (FT4) and thyroid stimulating hormone (TSH) respectively. Mean concentration of water fluoride in subjects of RM was 4.6 ×106 ng/L, urine fluoride 2.59 ×106 ng/L, serum fluoride 6.0 ×104 and dental fluorosis 90.5% respectively. Significant elevation (P = 0.000) in the concentration of three out of these four variables (P < 0.01) was observed (except in serum fluoride) in subjects of RM compared to those in the control group (OTW). Mean FT4, FT3 and TSH concentrations in RM subjects was 18.3 pmol/L, 5.06 pmol/L and 3.2 mlU/L respectively. No marked difference in FT4 and FT3 (P = 0.17 and P = 0.7) was found compared to the control (OTW) group, while significant elevation in TSH (P < 0.05) was found in. 22% of the children in the RM group, portrayed well defined thyroid hormonal aberrations. A negative correlation between water fluoride - FT4 (r = - 0.24); a strong positive between water, urine, serum, dental fluorosis and TSH (r = 0.94, 0.87, 0.88, 0.74 and 0.8) and moderate correlation between water fluoride - FT3 (r = 0.52) was observed. Results of this study indicate that the fluoride intoxication through drinking water is not only increasing fluoride level in body fluids and deteriorating teeth but also destroying thyroid function in a large number of children.

Hibiscus sabdariffa (H. sabdariffa), also known as roselle or red tea, is a member of the Malvaceae family, rich in anthocyanins and other bioactive compounds, which has been associated with a number of health benefits such as lowering of blood pressure and plasma cholesterol (1). The intake of H. sabdariffa has also been linked to prevention of diabetes, however, there is limited evidence on effects of H. sabdariffa on postprandial glycaemia and/or chronic markers of glycaemic control. A number of polyphenols have demonstrated potential in reducing blood glucose levels in an acute manner through modulation of postprandial glycaemic response when consumed with a carbohydrate source such as high starch foods, glucose and/or sucrose (2). The aim of our project was to investigate the in vitro inhibitory properties of H. sabdariffa on α-glucosidase enzyme activity and to confirm the findings in an in vivo glycaemic response study. Following incubation with different concentrations (0, 2.5-25 mg/ml) of aquaous extracts of H. sabdariffa, the activity of α-glucosidase was determined via spectrophotometer using p-nitrophenyl-α-D-glucopyranoside as substrate following a standard protocol. Acarbose was used as positive control and data are expressed as per cent inhibition. For the in vivo study, eight healthy volunteers (3 male and 5 females) were recruited, aged 19-23 years, who were asked to consume 400 ml of either hot water or hibiscus tea alongside a portion of white bread to provide 50 g available carbohydrates. The capillary blood was collected via finger prick in regular intervals following tea and bread consumption (0, 15, 30, 45, 60, 90, 120, 150 min). Blood glucose levels were determined using glucometer. Two-tailed paired t-test was used to analyse the data. The results from in vitro experiments demonstrate that H. sabdariffa preparations dose-dependently inhibited α-glucosidase activity with an IC 50 of 10 mg/ml extract (equivalent to 55.7 mg/ml anthocyanins). Overall, the in in vivo data (Fig. 1) do not show any differences following the intake of hibiscus tea in comparison to control (hot water) alongside white bread over the course of the 150 min experiment. The lack of effect on glucose response may be related to insufficient local concentrations of hibiscus but awaits further confirmation in a larger sample size. Our data indicate, that, although, in vitro experiments indicate the potential of H. sabdariffa to reduce carbohydrate digestion, under in vivo conditions, the acute consumption of H. sabdariffa might not relevant to reduce postprandial glucose response.

The parenting styles and psychological flexibility have been significant variables; however, little empirical work has addressed the impact of parenting in terms of the expansion of psychological flexibility. The present study investigated the impact of different parenting styles as a predictor of psychological flexibility in the adolescent population. A total sample of 100 adolescents (50 boys and 50 girls) whose ages ranged between 12 and 18 years without any previous psychiatric and medical history were recruited from different educational institutes of Pakistan. Results revealed that parenting styles are positively associated with psychological flexibility (r = 0.75, p < 0.05). Moreover, parenting styles significantly predict psychological flexibility among adolescents (p < 0.05). However, no gender differences were found across both variables among adolescents. These findings have highlighted the significance of parenting styles and psychological flexibility with respect to the mental health of adolescents.