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Consumption of sunflower seeds in Russia from marketing year 2019/2020 to 2021/2022 (in million metric tons)

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Global oilseed production 2020/21, by type.

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Palm oil: global production volume 2012/13-2020/21.

In beech-dominated forests in Central Europe, many spring geophytes show adaptations to seed dispersal by ants (myrmecochory). Ants, however, can be rare in such moist forests. Motivated by observations of slug feeding on seeds we investigated the seed consumption of two plant species, Anemone nemorosa and Asarum europaeum , by slugs, in a series of experiments. In a seed predation experiment in a beech forest, we found that seed removal was strongly reduced when gastropods were excluded from the seed depots. The contribution of insects, including ants, and rodents to seed removal was relatively less but differed between May and July. In the laboratory, slug species, in particular Arion sp., consumed seeds of both plant species. Slugs either consumed the elaiosomes of seeds or swallowed seeds intact. Swallowed seeds were defecated undamaged and germinated as well as control seeds when buried overwinter, indicating the potential for seed dispersal by slugs. We also recovered seeds of myrmecochores in the faeces of several slugs caught in forests. In a slug release experiment in the forest, slugs moved up to 14.6 m (mean 4.4 m) in 15 h, which is the median gut passage time of seeds based on measurements made in the laboratory. We also found that when slug-defecated seeds were offered to rodents, these were less attractive than control seeds, suggesting that passage through the slug gut reduces seed predation risk. Our results demonstrate that slugs are significant consumers of elaiosomes or entire seeds of ant-dispersed plants and that they can function as seed dispersers of these plants.

Several prospective studies have suggested a modest inverse association between coffee and risk of total and cause-specific mortality. In the AARP Diet and Health Study, 90 adjusted RRs for death among men who drank coffee as compared with nondrinkers were 0.99 for drinking less than 1 cup/d; 0.94 for 1 cup; 0.90 for 2 or 3 cups; 0.88 for 4 or 5 cups; and 0.90 for 6 or more cups of coffee/d (P<0.001 for trend); the corresponding RRs among women were 1.01, 0.95, 0.87, 0.84, and 0.85 (P<0.001 for trend). Inverse associations were observed for deaths due to CVD, respiratory disease, diabetes, and infections, but not for deaths due to cancer. Similar results were observed in two other large cohort studies, the Health Professionals Follow-up Study and the NHS. 91 Taken together, large prospective cohort studies have demonstrated that higher consumption of coffee is also associated with a moderately lower mortality risk.

More important than isolated foods or nutrients, the effect of overall dietary patterns on disease risk has become a new approach in nutritional epidemiology. 14 Plant-based dietary patterns, such as the “prudent” diet identified by Hu et al. 15 contain high amounts of vegetables, legumes, whole grains, and fruit and moderate amounts of fish, poultry, and low-fat dairy products. This dietary pattern has been associated with lower risk of CVD 16-20 and T2DM 21 and is widely recommended for heart health. 22 The traditional Mediterranean diet, which is akin to the prudent diet but has a higher total fat content in the form of olive oil and also alcohol (red wine) in moderation, has emerged as another dietary approach to chronic disease prevention, including CVD. 23,24.

1 Lipid Clinic, Endocrinology & Nutrition Service, Institut d’Investigacions Biomèdiques August Pi Sunyer, Hospital Clínic, Barcelona and CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain.

The nutrient density in the complex matrices of seeds probably explains the lower CVD risk observed with higher seed consumption. Many of these food constituents synergistically interact to beneficially affect various metabolic pathways intermediate in CVD and T2DM risk ( Figure ). We will briefly summarize the scientific evidence on the bioactivity of known seed components to provide a mechanistic frame for their cardioprotective benefits.

Data for raw products and 100 g serving size, except where specified.

Carbohydrate and fiber.

Mounting evidence from prospective studies indicates that higher intake of polyphenol-rich foods in general and of flavonoid-rich foods in particular is associated with protection from CVD, although potential publication bias and marked heterogeneity in results across studies 43,130 render the evidence inconclusive. The abundance of polyphenols in dark chocolate and coffee is thought to be responsible for the CVD benefit observed in high consumers. 52,53,57-60,80-83,86,87 A meta-analysis of 113 interventional studies of nearly 6000 subjects given different cocoa products or their pure phenolic extracts 55 demonstrated improvement in various intermediate markers of cardiovascular health, including blood pressure, endothelial function, blood lipids, and insulin sensitivity. Several of the intervention studies reviewed 55 were conducted with pure flavonoids and had effects similar to those elicited by the parent foods, which suggests that the benefit is at least partly due to these antioxidant molecules. However, no long-term RCTs have evaluated the effects of flavonoids or other phenolic compounds on clinical cardiovascular endpoints.

The integral role of seeds in pre-agricultural diets is understandable given their high energy and nutrient density. Seeds are also particularly important in human nutrition because of their unique composition in bioactive compounds. Of note, in the last decade a large body of scientific evidence has been built on the beneficial effects of increasing consumption of plant seeds and derived products on various health outcomes, chiefly CVD, T2DM, and intermediate markers. The purpose of this review is to summarize the state of the evidence for the cardiovascular health effects of plant seeds, a food category bound to have a prominent place in health-promoting diets.

Numerous epidemiologic studies have examined consumption of edible seeds in relation to risk of CVD, T2DM, or mortality, and meta-analyses summarize the observational evidence. Meta-analyses have also been published on the effects of these foods on blood cholesterol, glycemic control, blood pressure, or vascular function from small, usually short-term, RCTs. Table 3 lists the latest meta-analyses and their main results. 45-61.

Among seeds, nuts and chocolate have the highest total fat content ( Table 1 ). However, except for chocolate (rich in stearic acid), seeds have a low SFA content and most fat is made up of unsaturated fatty acids, with variable proportions of MUFA and essential PUFA, such as linoleic and α-linolenic acids, the latter being particularly abundant in walnuts. 32 While not as much investigated as marine n -3 fatty acids, in observational studies higher exposure to α-linolenic acid has been associated with a moderately lower risk of CVD. 92 It has been known for decades that SFA intake raises blood cholesterol, while replacing SFA with MUFA or PUFA decreases blood cholesterol, 3-5,93 with parallel effects on CVD risk. 1,24 As mentioned, stearic acid, the predominant fatty acid in cocoa products, does not raise blood cholesterol. 40,93 On the other hand, substituting SFA with unsaturated fatty acids, either MUFA or PUFA, improves insulin sensitivity and likely reduces the risk of T2DM (reviewed in 94 ). Thus, by way of salutary effects on lipid and glucose metabolism, the fat fraction of seeds could help reduce the risk of CVD and T2DM.

After decades of epidemiologic and clinical research, the influence of overall diet on health and disease, particularly coronary heart disease (CHD), has become widely accepted. 1 The pioneering ecological and metabolic studies of Keys and colleagues placed the focus on fat types, showing that populations consuming more saturated fatty acids (SFA) had higher blood cholesterol levels and associated higher rates of coronary heart disease (CHD), 2 while individuals fed SFA had increased blood cholesterol levels, as opposed to the effects of monounsaturated (MUFA) or polyunsaturated fatty acids (PUFA). Cholesterol changes derived from switching fatty acid species in the diet were found to be predictable with specific equations. 3-5 Subsequent epidemiologic studies confirmed that elevated serum cholesterol was a strong independent risk factor for CHD. This led to the formulation of the diet-heart hypothesis, whereby high intake of saturated fats leads to elevated cholesterol levels, which in turn promote atherosclerosis, coronary artery occlusion, and subsequent ischemic events. 6 Though the diet-heart hypothesis shaped dietary guidelines towards reduction of all dietary fat, with a concomitant increase in carbohydrates, it proved futile in reducing the incidence of cardiovascular disease (CVD) in women. 7 However, no randomized controlled trial (RCT) of a low-fat diet for effects on CVD events has been conducted in men. In the last three decades, the decreasing fat consumption as percentage of energy in the US population has done little to slow the increasing rates of obesity and type 2 diabetes mellitus (T2DM). 8 It is now widely recognized that higher-fat diets can be beneficial if healthy fats are consumed, while high-carbohydrate diets (particularly those with high glycemic load) might be contributing to CHD 9-12 and other negative health outcomes. 12,13 As reviewed here, healthy, plant-based unsaturated fats are major components of widely consumed edible seeds, such as tree nuts and peanuts.

Nuts are dry fruits with one seed in which the ovary wall becomes hard at maturity. The most popular edible tree nuts are almonds, walnuts, hazelnuts, and pistachios. Other common edible nuts are pine nuts, cashews, pecans, macadamias, and Brazil nuts. 31 The consumer definition also includes peanuts, which botanically are legumes but are widely identified as part of the nuts food group. In addition, peanuts have a similar nutrient profile to tree nuts. 32.

Like all plant foods, seeds are cholesterol-free, but their fatty fraction contains sizeable amounts of chemically related non-cholesterol sterols known as plant sterols or phytosterols, non-nutritive components that play important structural roles in membranes. 29 Relevant for human physiology, phytosterols interfere with cholesterol absorption in the intestinal lumen and thus possess cholesterol-lowering properties. 106 Phytosterols are established non-pharmacological agents that are useful adjuncts to a healthy diet for helping lower serum total and LDL-cholesterol, resulting in average reductions of 10% at the usually recommended doses of 2 g/d, 107 an effect additive to that of statins. 108 However, at doses up to 2 g/d, the effect of phytosterols is dose-related; 107 doses as low as 400 mg/day, easily achieved with frequent intake of various seed products ( Table 2 ), were shown to significantly influence cholesterol metabolism and reduce LDL-cholesterol by an average 5% in moderately hypercholesterolemic individuals. 109 There is also consistent experimental evidence that phytosterols possess anti-inflammatory properties, though clinical studies have proven inconclusive. 110.

Two studies have examined the association between pulse consumption and risk of CVD. 75,76 In the First National Health and Nutrition Examination Survey (NHANES) Epidemiologic Follow-up Study, frequency of pulse plus peanut and peanut butter consumption was inversely associated with incidence of CHD and CVD during a 19-y follow-up. Legume consumption ≥4/wk compared with <1/wk was associated with a 22% lower risk of CHD (adjusted risk ratio [RR] 0.78; 95% CI, 0.68-0.90) and an 11% lower risk of CVD (adjusted RR 0.89; 95% CI, 0.80-0.98). 75 A case-control study conducted in Costa Rica, where dry beans are a staple, compared bean intake in 2119 survivors of a first acute myocardial infarction (MI) with matched population controls. Compared with non-consumers, one serving of beans/d was inversely associated with MI, with an adjusted odds ratio (OR) of 0.62 (95% CI, 0.45-0.88). 76 In another report on that study’s control population, substituting one serving of beans for one serving of white rice was associated with a 35% (95% CI, 15%-50%) lower risk of having the metabolic syndrome, related mainly to a decreased frequency of low HDL-cholesterol and high fasting glucose. 77 Similar findings were reported from the NHANES 1999-2002; compared to non-consumers, bean consumers had significantly lower body weight, smaller waist circumference, and lower systolic blood pressure. 78 The risk of T2DM associated with pulse consumption has not been specifically assessed in epidemiologic studies. However, pulses are an important component of dietary patterns clearly related to a lower T2DM risk, such as low-GI, high-fiber, and Mediterranean diets. 21.

Grains, nuts, legumes, and cocoa products represent a sizable contribution to human energy consumption in various populations, while daily coffee drinking is customary for many individuals worldwide. Many other edible seeds that are sparingly consumed and/or contribute only marginally to energy intake will not be dealt with here: pepper, mustard, cumin, capers and other seasoning seeds; flax, hemp, pumpkin, sesame, and sunflower seeds; berries; and others like coconut.

Prior to the Industrial Revolution, all cereals were stone-milled and contained the entire constituents of the grain kernel. 62 The advent of industrialized roller milling at the end of the 19 th century significantly changed the nutritional quality of milled grain. In the 1970’s Burkitt and Trowell pioneered the link between chronic disease and refined grain by observing that Africans who consumed large quantities of whole plant foods had a lower prevalence of chronic diseases than Western countries where grain products are highly processed. 63 Whole grains are comprised of germ, bran, and endosperm. In contrast, refining removes both the germ and bran along with fiber, vitamins, minerals, phenolic compounds, and phytochemicals. 30,64 The unique constellation of constituents is thought to confer the beneficial effects of whole grains on chronic disease risk via mechanisms shared by all seeds (see section on Mechanisms for Beneficial Effects of Seeds).

Introduction.

Average Nutrient Composition of Selected Seeds and Seed Products.

Phenolic compounds are strong antioxidants ubiquitous in plants. They are structurally diverse, belonging to several families such as benzoic acid derivatives, flavonoids, proanthocyanidins, stilbenes, coumarins, lignans, and lignins. 41,126 Several thousand molecules with structural features of polyphenols (one or more phenolic rings with a variable number of hydroxyl groups) have been isolated from higher plants, and nearly 500 have been identified in various plant-based foods and beverages. 42 Seeds, particularly nuts, pulses, and cocoa products, are particularly rich in polyphenols ( Table 2 ), but they are present mostly in the outer layers and many are heat-labile. Thus peeling or roasting nuts, decortication of cereals, or dehulling of pulses results in sizeable losses, as do boiling, frying, and microwave heating. 126,127.

Recently, the final results of the landmark PREDIMED RCT have been published showing for the first time a reduction of incident CVD after long-term consumption of a diet enriched in seeds. 74 The PREDIMED study was a multicenter, nutrition intervention, primary prevention trial conducted in Spain wherein nearly 7500 participants at high cardiovascular risk, but with no cardiovascular disease at enrollment, were randomly assigned to one of three diets: a Mediterranean diet supplemented with daily doses of 30 g of mixed nuts (15 g walnuts, 7.5 g almonds, and 7.5 g hazelnuts), a Mediterranean diet supplemented with extra-virgin olive oil (1 liter per week), or a control diet (advice to reduce dietary fat). After a median follow-up of 4.8 years, the participants in the two Mediterranean diet groups showed a 30% reduction in CVD events (myocardial infarction, stroke or cardiovascular death) compared with the control diet. The nut diet was also associated with a significant 49% reduction in risk of stroke. Of note, the interventions were intended to improve the overall dietary pattern, but the major between-group differences in food intake were for the supplemental items. Thus, nuts were probably responsible for most of the observed benefits in the Mediterranean diet with nuts group. The results of the PREDIMED trial 74 show the full potential of nuts and other healthy foods such as extra-virgin olive oil to improve cardiovascular health.

Regarding dietary minerals and T2DM, limited evidence from prospective studies suggests that Ca ++ intake relates inversely to risk. 118 Observational studies more strongly support an independent protective role of Mg ++ intake against T2DM, with a dose-response effect translating into a 14% risk reduction for each 100 mg/d increment in Mg ++ intake. 119 This dose of Mg ++ is easily obtained with feasible daily servings of seeds and seed products ( Table 2 ). Dietary K + could also play a preventive role against T2DM, as suggested by findings from the NHS after a 6-year follow-up; 120 to our knowledge, there have been no further studies examining this association. Increasing intake of non-sodium minerals influences the risk of T2DM through their critical participation in intracellular processes related to glucose homeostasis, such as a cofactor role for enzymes involved in glucose transport, enhanced insulin signaling, and modulation of glucose-induced insulin secretion, which all lead to increased insulin sensitivity. 119,121 Besides blood pressure reduction, 117 increased intake of K + , Mg ++ , and Ca ++ in the DASH dietary pattern is also believed to underlie its effect of improving insulin sensitivity, 122 an example of multi-purpose nutrient synergy.

Seeds contain little sodium but are rich in K + , Mg ++ , and Ca ++ . All three are critical in cellular metabolism and many physiologic processes, of which blood pressure regulation has been most studied. 111 Whereas high sodium (salt) intake is associated with significantly increased risk of stroke and total CVD, 112 intake of non-sodium minerals generally has the opposite effect. A meta-analysis of prospective studies relating dietary Ca ++ intake with risk of CVD showed non-significant reductions of 8% for incident CHD and 14% for incident stroke comparing the highest to the lowest level of dietary Ca ++ intake. 113 Two similar meta-analyses have shown a significant inverse association between dietary K + intake and risk of stroke, with a decrease in risk of 21% for every 1.64 g/d 114 or 11% for every 1.0 g/d 115 increase in dietary K + intake. The latter dose of K + can be obtained from combining seed servings in the usual diet ( Table 2 ). The association of dietary K + with lower CHD risk, however, is only suggestive. 114 Concerning dietary Mg ++ intake, a meta-analysis of prospective studies by Larsson et al. 116 shows a modest but significant inverse association with stroke risk, with an 8% reduction for an increment of 100 mg/d in intake. Hypertension is the main risk factor for cerebrovascular disease; thus the stronger beneficial effect of reducing sodium and increasing non-sodium mineral intake from dietary sources on stroke risk than CHD risk is ascribable to reductions of blood pressure. 111 Indeed, changes in dietary mineral intake like those derived from increased seed consumption are believed to be instrumental in the substantial blood pressure-lowering effect of the Dietary Approaches to Stop Hypertension (DASH) diet. 117.

Among seeds, nuts are particularly rich in vitamin E compounds, mainly α-tocopherol, a well-known antioxidant that, together with vitamin C, carotenoids, and selenium, contributes to the body’s defense against reactive oxygen species. α-Tocopherol, the biologically most active and most frequently studied form of vitamin E, is a lipid-soluble molecule transported in blood in lipoprotein fractions that acts as a peroxyl radical scavenger in lipid environments, preventing lipid peroxidation in lipoproteins and membranes. By reducing LDL oxidation or other mechanisms, vitamin E also displays anti-inflammatory properties, inhibits platelet aggregation, and enhances NO bioavailability. 123 This helps explain the beneficial health effects of lifelong high intake of vitamin E. Thus, a large meta-analysis of 15 cohort studies reported that vitamin E intake was associated with a reduced CHD risk, with RR=0.76 (95% CI, 0.63-0.89) for the top tertile compared with the bottom tertile of intake. 124 However, large-scale RCTs have shown an unexpected lack of efficacy for different doses of supplemental vitamin E or other antioxidants against CVD. 125 A likely reason for the discrepancy between prospective studies and RCTs is that the latter usually enrolled patients with prior CHD or at high risk of CVD; established atherosclerotic damage is unlikely to regress with antioxidant treatment. Likewise, there is no evidence from RCTs that vitamin E helps prevent or manage T2DM. 121 Hence, the use of vitamin E or other antioxidant vitamin supplements for CVD prevention is discouraged, while the recommendation stands for a healthy diet, rich in food sources of antioxidant nutrients such as fruits and vegetables, including seeds. 22.

A meta-analysis by Mellen et al. 65 of seven prospective cohorts found a 21% lower risk of CVD for greatest compared with lowest whole grain intake. A more recent meta-analysis of 45 prospective cohort studies 45 showed that, compared with participants who rarely or never consumed whole grains, those reporting an average intake of 48–80 g/d (3–5 serving/d) had a 21% lower risk of CVD and a 26% lower risk of T2DM ( Table 3 ). Based on data from 21 short-term RCTs, this meta-analysis also found that whole grain interventions significantly reduced total and LDL-cholesterol and fasting glucose. de Munter et al. 46 conducted a meta-analysis of six prospective cohort studies and found a 21% reduction of T2DM risk for two servings/d increment in whole grain intake. The inverse association was stronger for bran than for germ, and there was no independent association for germ intake after adjustment for bran intake. These results provide some evidence to support independent benefits of bran, although it is often difficult to tease out the effects of the individual components of a whole food.

Frank B. Hu.

SFA indicates saturated fatty acids; MUFA, monounsaturated fatty acids; PUFA, polyunsaturated fatty acids.

Polyphenols are strong antioxidants, but evidence is increasing of their pleiotropic effects, i.e., flavanols, a type of phenolic abundant in cocoa and black tea, increase the availability of NO, which may explain their favorable vascular effects. 128 In an acute study in heart-transplant recipients, flavanol-rich chocolate induced coronary vasodilation and a decrease in platelet adhesion, concomitant with a reduction in measures of oxidative stress in comparison with a similar product devoid of flavanols. 84 Some flavonoids have been shown to inhibit NF-kB, a critical pro-inflammatory protein that enhances the expression of cytokines and cell adhesion molecules. 129 However, the precise molecular mechanisms underlying these beneficial effects remain elusive.

Except for coffee as beverage, which contains very low amounts of macronutrients, whole seeds are important sources of slow-release carbohydrate and dietary fiber, a non-absorbable nutrient that has received much attention in nutritional epidemiology. There are two main types of dietary fiber: metabolically inert insoluble fiber and bioactive soluble or viscous (gel-forming) fiber, which has cholesterol-lowering properties and reduces postprandial glucose responses after carbohydrate-rich meals. 95 With the exception of oat and barley, rich in soluble beta-glucans, whole grains contain little soluble fiber but are rich in insoluble fiber (bran), while the main sources of soluble fiber in the usual diet are fruit and vegetables. Observational studies have consistently shown that increased intake of dietary fiber, usually from cereals rather than fruit and vegetables, is associated with reduced incidence of CVD and T2DM. 45,96 The reason for this apparent contradiction is that, in epidemiological studies, insoluble fiber cannot easily be dissociated from whole-grain foods, which provide many other bioactive phytochemicals associated with beneficial health effects, as discussed here. Dietary fiber may also reduce CVD and T2DM risk through blood pressure reduction, improvement of insulin sensitivity, changes in secretion of various gut hormones that may act as satiety factors, and anti-inflammatory effects. 97.

For this narrative review we conducted a comprehensive search of MEDLINE and EMBASE through December 2012 for English language descriptions of seed composition, reports of epidemiologic and clinical studies describing effects of seeds (whole grains, tree nuts and peanuts, pulses, cocoa and cocoa products such as chocolate, and coffee) on cardiometabolic outcomes, and the most recent reviews and meta-analyses of these studies. We also searched for reviews and meta-analyses of the effects of the main bioactive seed components on the same outcomes. Finally, we searched references cited in original studies and reviews identified, together with papers citing landmark clinical studies, reviews and meta-analyses, as provided by the publishers of individual articles in their websites. Data were examined for relevance, quality, and consistency and independently extracted by the two authors, who reached a consensus when in doubt about a specific citation. Given that, up to the time of submission, few controlled trials on the effects of seed consumption on clinical end points had been published, we have derived the core of scientific evidence from prospective cohort studies reporting disease outcomes and randomized clinical trials (RCTs) with intermediate end points, with a particular emphasis on meta-analyses of such studies.

Over 50 short-term RCTs have compared the effects of nut-enriched and nut-free diets on blood lipids and lipoproteins. A meta-analysis of 13 walnut feeding studies 48 and a recent pooled analysis of 25 RCTs using various nuts 49 indicate a consistent cholesterol-lowering effect ( Table 3 ). In the pooled analysis LDL-cholesterol was reduced by 7.4% for an average consumption of 67 g (2.4 oz) of nuts depending on nut dose and baseline LDL-cholesterol, and was similar by gender and age group and independent of the type of nut tested. 49 Acute feeding studies indicate that nuts reduce postprandial glucose responses when consumed with foods having a high glycemic index (GI), which suggests that they may be useful in diabetic control. 69 Importantly, recent evidence from the PREDIMED (PREvención con DIeta MEDiterránea) intervention trial in Spanish subjects at high cardiovascular risk showed that a Mediterranean diet with one daily serving of mixed nuts reduced incident T2DM by 52% (95% confidence interval [CI], 4%-76%) after 4 years compared with a control diet. 70 Limited evidence from RCTs suggests that nuts, particularly walnuts, have beneficial effects on blood pressure and endothelial function. 71 Nut feeding studies have also documented reduced circulating concentrations of inflammatory cytokines but no consistent changes of C-reactive protein. 72 Finally, in spite of the high energy density of nuts, there is no evidence that their frequent consumption promotes obesity, probably because of a prominent satiating effect. 68 In the PREDIMED trial, the Mediterranean diet supplemented with nuts significantly reduced the prevalence of metabolic syndrome compared with the control diet after 1-year follow- up, mainly by reducing waist circumference. 73.

Consumption of seeds improves cardiovascular health due to their unique composition in bioactive nutrients and phytochemicals and a complex synergy among them for effects on metabolic and vascular physiology pathways. The main known nutrients of seeds are represented together with their principal biological targets (long arrow connections). The net effects on intermediate markers of cardiovascular risk that have been demonstrated for most seed classes in clinical trials are cholesterol-lowering, improved glycemic control, decreased blood pressure, improved vasomotion, reduced platelet aggregation, and antioxidant and antiinflammatory actions. The overall result is reduced CVD and/or T2DM, as suggested for all seeds in observational cohort studies and observed for nuts in clinical trials. See text for details. Abbreviations: carb, carbohydrate, GI, glycemic index; K, potassium; Mg, magnesium; Ca, calcium; NO, nitrous oxide; FMD, flow-mediated vasodilation.

Pulses are the seeds of leguminous plants contained within pods. Lentils, chickpeas, black-eyed peas, and a variety of dry beans, including pinto, kidney, navy, and fava beans, are the most common edible pulses. 33 The term “pulses” excludes legumes used for oil extraction, such as soybeans and peanuts, and those harvested green, such as green peas and green beans, which are classified as vegetables. Pulses usually require cooking prior to consumption and are eaten untransformed, unlike soybeans, which are the basis for soy oil and various foods such as tofu and derived products, widely consumed in Asia and by vegetarian populations worldwide.

Effect of Seed Consumption on CVD Outcomes Based on Selected Meta-analyses of Findings of Epidemiologic Studies and Randomized Clinical Trials.