Hibiscus sabdariffa Meal Improves Iron Status of Childbearing Age Women and Prevents Stunting in Their Toddlers in Northern Ghana

Evaluating the potential of Hibiscus sabdariffa beverage to address the prevalence of iron deficiency in sub-Saharan Africa

The potential of Hibiscus sabdariffa L. beverage as a dietary iron source for sub-Saharan Africans was investigated. The target was to provide 6 mg of iron through 250 mL of the beverage daily. However, the iron content of the dried hibiscus calyces was determined to be 9.73 ± 0.31 mg/100 g and from that only ∼30% was extractable, resulting in 0.93 ± 0.19 mg Fe/250 mL of the selected beverage formulation. Therefore, ferrous sulfate was explored as a fortificant. The beverage contains polyphenols which could form non-absorbable chelation complexes with iron during digestion. Subsequently, the effect of polyphenols on the bioaccessibility of native and added iron was assessed using spectrophotometric methods. The presence of iron-polyphenol complexes in samples of the unfortified and fortified beverages, adjusted to pH 6.5 (pH at site of iron absorption in the gut) was established. However, only ∼25% of the added iron was found to be bound in the complex. It was shown that the viability of H. sabdariffa L. beverage as an iron source is impacted by extraction losses and the inhibitory effect of polyphenols. Nonetheless, if iron-polyphenol complexation was reduced/prevented then, a fortified hibiscus beverage could be a useful iron source.

Physiological Effects and Human Health Benefits of Hibiscus sabdariffa: A Review of Clinical Trials

Hibiscus sabdariffa Linn. Malvaceae (HS) is characterized by its edible calyxes. The HS calyxes are widely used for cosmetic, food, and medicinal applications. According to ethnobotanical evidence, decoction, infusion, or maceration extracts from HS calyxes have been used in folk medicine to treat many ailments. Moreover, several in vitro and in vivo studies have demonstrated the pharmacological properties and potential human health benefits of HS consumption. On the other hand, the evaluation of the physiological effects and health benefits of HS in clinical studies is most challenging. Therefore, this narrative review summarizes and discusses the physiological effects and health benefits of HS calyxes reported in clinical trials. Preparations obtained from HS calyxes (extracts, infusions, decoction, teas, beverages, capsules, and pills) are used as non-pharmacological therapies to prevent/control diverse chronic non-communicable diseases. The most-reported HS health benefits are its antihypertensive, antidyslipidemic, hypoglycemic, body fat mass reduction, nephroprotective, antianemic, antioxidant, anti-inflammatory, and anti-xerostomic activities; these effects are associated with the phytochemicals found in HS. Moreover, no adverse effects were reported during the clinical trials. However, clinical studies exhibited some limitations; thus, further studies are required to validate the clinical efficacy of HS in large-scale studies with higher doses and a good experimental design

Changes of Serum Ferritin, Hemoglobin, and Serum Iron (SI) and Treatment Effect of Iron Proteinsuccinylate Oral Solution Combined with Vitamin A and D Drops on Children with Nutritional Iron Deficiency Anemia

Objective

The purpose was to evaluate the treatment effect of iron proteinsuccinylate oral solution combined with vitamin A and D drops on children with nutritional iron deficiency anemia.

Methods

124 children treated in the outpatient department of our hospital from January 2017 to January 2020 were selected as the study subjects. They were randomly divided into control and observation two groups. The control group was treated with iron proteinsuccinylate oral solution (1.5 mL/kg) in the morning and evening, respectively. The observation group received adjuvant treatment with oral vitamin A and D drops based on the treatment of the control group. The treatment effect of proteinsuccinylate oral solution combined with vitamin A and D drops was evaluated by the serum iron (SI), serum ferritin (SF), and transferrin (TRF) levels, the values of CD3⁺, CD4⁺, and CD4⁺/CD8⁺, and other evaluation indicators.

Results

After treatment, the SI and SF levels of children in both groups significantly increased (P < 0.01) while the TRF level significantly decreased (P < 0.01), and the SI and SF levels in the observation group increased more significantly, and the TRF level decreased more significantly compared with those in the control group (P < 0.01). After treatment, the values of CD3⁺, CD4⁺, and CD4⁺/CD8⁺ of children in both groups significantly increased compared with those before treatment (P < 0.01), and the values of CD3⁺, CD4⁺, and CD4⁺/CD8⁺ increased more significantly in the observation group compared with those in the control group (P < 0.01). In addition, the evaluation results of treatment effect showed that the markedly effective rate in the observation group was significantly higher than that in the control group (P < 0.01).

Conclusion

Iron proteinsuccinylate oral solution combined with vitamin A and D drops can better improve the anemia symptoms in children, with high application value.

Effect of perinatal administration of flavonoid-rich extract from Hibiscus sabdariffa to feed-restricted rats, on offspring postnatal growth and reproductive development

Developmental programming is a process where stimulus or insult acting during critical periods of growth and development might permanently alter tissue anatomy and physiology so as to produce adverse effects in adult life. Most forms of exposure include maternal nutrient deprivation, nutrient excess, exogenous glucocorticoid excess and endogenous glucocorticoid due to maternal stress. Hibiscus sabdariffa (Hs) are highly rich in phenolic compounds with marked physiological activities, the sweetened aqueous extract of Hs, commonly known as “Zobo’ in Nigeria, is consumed by humans including pregnant and lactating mothers. This study aimed at determining effects of perinatal administration of flavonoid-rich extract from Hs to feed-restricted rats, on offspring postnatal growth and reproductive development. Twenty-five pregnant female rats were used. Rats were randomly placed into five groups of five rats per group (one animal per cage): Group I (Normal control); Group II (feed-restricted control); Group III (5 mg/kg extract + 70% feed-restricted diet); Group IV (10 mg/kg extract + 70% feed-restricted diet); Group V (20 mg/kg extract + 70% feed-restricted diet). Dams were allowed to nurse only 8 pups. Pups were weaned to ad libitum feed and water and were observed daily for puberty onset. Weights, lengths and body mass index (BMI) of pups were measured at delivery, weaning and puberty onset. At onset of puberty in each of the rats, blood samples were collected for determination of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol and testosterone. Reproductive organs were excised and weighed for histology. The extract caused significant increase in postnatal weight, length and BMI of offspring at birth, weaning and puberty onset and significantly delayed puberty onset in both sexes. There was significant increase in absolute and relative weights of testes and ovaries with alterations in histology. This study has shown that maternal consumption of flavonoid-rich extract of Hs during pregnancy and lactation may accelerate offspring postnatal growth with delay in onset of puberty.

Association between Infant and Young Child Feeding (IYCF) Indicators and the Nutritional Status of Children (6-23 Months) in Northern Ghana

Although recommended infant and young child feeding (IYCF) practices have been found to be protective against undernutrition in some settings, there is no finality yet due to inconsistencies in the literature. A cross-sectional survey of 581 mother-child pairs was conducted in northern Ghana in June 2018. The association between IYCF indicators and child undernutrition (stunting and wasting) were assessed. The descriptive analysis showed that 66.4% of the children (6-23 months) were introduced to complementary feeding in a timely manner, 69.4% met the minimum meal frequency, and 38.9% met the minimum acceptable diet daily. The prevalence of stunting, wasting, underweight and overweight was 33.2%, 14.1%, 27% and 2.6%, respectively. From the multivariable binary logistic regression, child gender, child age group and source of power for lighting the household were significantly associated with wasting. Intake of iron-rich foods, child age group, and maternal height were significantly associated with stunting after adjusting for confounders. The prevalence of the compliance with IYCF indicators was relatively high. None of the individual IYCF indicators showed significant association with undernutrition, except intake of iron-rich foods for stunting. Nutrition-specific interventions targeted at improving IYCF practices, dietary diversification and intake of nutrient-rich meals, should be adopted and scaled up to address undernutrition in northern Ghana.

Potential Application of Tetrapleura tetraptera and Hibiscus sabdariffa (Malvaceae) in Designing Highly Flavoured and Bioactive Pito with Functional Properties

Sorghum beer (pito) is an indigenous alcoholic beverage peculiar to northern Ghana and parts of other West African countries. It is overwhelmed with calories, essential amino acids (such as lysine, etc.), B-group vitamins, and minerals. In recent years, there has been a growing demand for highly flavoured yet functional pito in Ghana; however, the local producers lack the prerequisite scientific expertise in designing such products. We propose the utilization of Tetrapleura tetraptera (TT) and Hibiscus sabdariffa (HS) as cheap and readily available materials in designing functional flavoured pito. The addition of TT and HS would not alter the fermentation profile but rather augment the starter with nutrients, thus improving the fermentation performance and shelf life of the final pito. In vitro and in vivo studies provide substantive evidence of antioxidant, nephro- and hepato-protective, renal/diuretic effect, anticholesterol, antidiabetic, and antihypertensive effects among others of the TT and HS, hence enriching the pito with health-promoting factors and consequently boosting the health of the consumer. Herein, we summarise the phytochemical, biological, pharmacological, and toxicological aspects of TT and HS as well as the technology involved in brewing the novel bioactive-flavoured pito. In addition, we also report the incidence of heavy metal in conventional pito.

Food-based indicators are related to iron and iodine deficiencies of mother-toddler dyads during the lean season in northern Ghana

Fe and iodine deficiencies are among the common forms of nutritional deficiencies globally and cause detrimental effects on mother and child. In developing countries, strategies to address these problems rarely use preventative dietary approaches. This cross-sectional study aims to ascertain whether dietary diversity score (DDS) and dietary patterns (DP) can predict the associated risk (AR) of Fe and iodine deficiencies in mother-toddler dyads during the dry/lean season in northern Ghana. Data were collected from women (15-49 years; n 118) and their toddlers (6-23 months, n 121). Dyads DDS and DP were calculated from their food intake recall. Multivariable logistic regression models were used to examine whether DDS, DP and socio-demographic factors predict higher odds of Fe and iodine deficiencies in dyads. DDS and DP predicted Fe and iodine deficiencies AR. Compared with DDS ≥4, women with DDS <4 have higher odds of Fe deficiency (ID) (adjusted OR (AOR) 1·82, 95 % CI 1·03, 3·21) and iodine deficiency (AOR 9·73, 95 % CI 3·19, 29·67). Two DP emerged in principal component analyses, 'rural elites diet' predicted ID risk in mothers (AOR 8·65, 95 % CI 1·76, 42·39), while 'indigenous diet' predicted iodine deficiency risk (AOR 11·41, 95 % CI 1·36, 95·97) in mothers only. The AR of Fe and iodine deficiencies in vulnerable populations may be predicted by diet-based measures in northern Ghana. We recommend further research into DDS and DP to predict Fe and iodine status of mother-toddler dyads in Ghana.

Iodine status of reproductive age women and their toddlers in northern Ghana improved through household supply of iodized salt and weekly indigenous meal consumption

Iodine deficiency (ID) during pregnancy results in pregnancy losses, intrauterine growth retardation, and lower IQ in the offspring. Even after two decades of universal salt iodization (USI) implementation, the efficacy of USI has not been reported in high risk groups in vulnerable regions in Ghana. We aimed to assess and improve ID status in childbearing age women (all lactating women) and their toddlers in northern Ghana, a geographically and socioeconomically vulnerable region. We provided weekly supply of household iodized salt and community-based feeding of native Hibiscus Sabdariffaa leaves meal (HSM) prepared with iodized salt to women and their toddlers in intervention (n = 60) vs. control group (n = 60). At baseline, ID was prevalent in women (36%) and their toddlers (29%). For women, both median UIC values for intervention (57.4 ug/l) and control group (65.1 ug/l) were below the recommended UIC value of 100 ug/l with no significant differences between the two groups (p = 0.2778). At the endpoint, median UIC for the intervention group (123.6 ug/l) was significantly higher (p = 0.008) than the control group (59.7 ug/l). Our results suggest that weekly supply of iodized salt along with the feeding HSM is an effective channel for improving iodine status of economically disadvantaged groups in communities remote from coastal lands. Furthermore, our results suggest that decreased median UIC among lactating mothers does not necessarily imply lower iodine status for their breastfed toddlers. And finally, the observed median UIC<100 ug/l may point to a non-improvement in iodine status for the past decade for Ghana. There is a need to revisit, assess, and ascertain the challenges in preventing populations from attaining the intended benefits of the USI policy in Ghana.