Table 4.

Effects of HS consumption on blood lipids.

Country	Sex		Age (years)	Dose	Frequency/Days of Intervention	Sample Size		Design Study	Notes about Participants	Main Results	Ref.
	M	F				Exp.	CT
Infusion/Decoction/Tea
Saudi Arabia	0	16	25–35	2 g	6 weeks	16	0	NI	Female participants	Lowering the OxLDL levels of participants. Anthocyanins were able to inhibit OxLD	[22,102]
Iran	6	37	30–60	2 g	12 weeks	21	22	R, C	Adults with polygenic dyslipidemia	The intervention group showed a significant reduction in total cholesterol and LDL-c	[19]
Iran	35	37	14–21	2 g	NI	36	36	R, P, C	Adolescent population	Serum total cholesterol, LDL-c, and TGL showed a decrease in all cases	[120]
Iran	8	45	55.37 ± 8.6	2 g	1 month	27	26	R, C	Patients with diabetes	HS decreased TGL, CT, LDL-c, and APO-B100 levels; it also increased HDL-c levels	[122]
Iran	NI	NI	50 ± 14	15 mg	30 days	42	42	R	Patients with hypertension were treated for at least 3 months.	No significant differences were found between pre and post-experiment measurements in the groups evaluated	[126]
Iraq	9	15	31–65	15 g	4 weeks	NI	NI	P, R, CC	Hypertension patients	The HS group showed the most significant decrease in blood pressure, cholesterol, and LDL and a decrease in urea nitrogen	[125]
Indonesia	0	18	>60	2 g twice a day	21 days	9	9	Q, CT	Subjects with metabolic syndrome	HS group reduced TC, TG, HDL, and LDL in the elderly with dyslipidemia	[112]
Capsule/Tablet
Mexico	NI	NI	30–71	100 mg	1 month	51	73	R, P	Metabolic syndrome diagnosed according to NCEP-ATP III criteria	Hypolipidemic and hypotensive effects were reported.	[9]
China	16	26	18–75	500 mg per capsule	4 weeks	NI	NI	R, CO	Volunteers with elevated cholesterol without supplement or medication intake	HS promoted a significant decrease in serum cholesterol levels	[33]
China	21	15	18–65	450 mg	12 weeks	19	17	DBT, R	Obese subjects	HS capsules did not promote changes in HDL and LDL levels	[20]
Iran	NI	NI	47.66 ± 4.32 (HS)	500 mg	4 weeks	18	170	DBT, C, CT	Adults with metabolic syndrome	HS decreased systolic blood pressure and TGL with respect to control	[117]
India	31	26	35–60	1 g	90 days	28	29	R, DBT, PC	Subjects without chronic diseases with 130–190 mg/dl serum LDL values.	The experimental group showed a 10% reduction in triglyceride values, and the placebo group showed no significant change	[123]
Beverage
Cameroon	32	0	25.38 ± 3.35	35 g	2 weeks	32	0	NI	Subjectswere advised not to consume HS from any other source during the experimental period	Reduced the total cholesterol and LDL-c and increased HDL-c	[121]
Indonesia	17	13	39.33 ± 9.18	200 ml	30 days	NI	NI	NI	Healthy adults	HS significantly lowered blood pressure and increased HDL	[124]

HS: Hibiscus sabdariffa; M: male; F: female; Exp: experimental group; CT: control group; NI: no information; OxLDL: low-density lipoprotein from human; R: randomized trial; C: controlled trial; TC: total cholesterol; LDL-c: low-density lipoprotein-cholesterol; P: prospective trial; TGL: triglycerides; APO-B100: apolipoprotein B-100; HDL-c: high-density lipoprotein-cholesterol; CC: clinical case-control; BP: blood pressure; Q: quasi-experimental; CO: cross-over trial; DBT: double-blind trial; PC: placebo control.