Why should pistachio be a regular food in our diet?

Citation: Mateos, R.; Salvador, M.D.; Fregapane, G.; Goya, L. Why Should Pistachio Be a Regular Food in Our Diet? Nutrients 2022,14, 3207. https://doi.org/10.3390/ nu14153207 Academic Editor: Justyna Godos Received: 14 July 2022 Accepted: 2 August 2022 Published: 5 August 2022 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). nutrients Review Why Should Pistachio Be a Regular Food in Our Diet? Raquel Mateos 1,*, María Desamparados Salvador 2, Giuseppe Fregapane 2and Luis Goya 1,* 1Institute of Food Science, Technology and Nutrition (ICTAN-CSIC), Spanish National Research Council (CSIC), JoséAntonio Nováis 10, 28040 Madrid, Spain 2Facultad de Ciencias y Tecnologías Químicas, Universidad de Castilla-La Mancha, Camilo JoséCela n◦10, 13071 Ciudad Real, Spain *Correspondence: [email protected] (R.M.); [email protected] (L.G.) Abstract: The pistachio is regarded as a relevant source of biologically active components that, compared to other nuts, possess a healthier nutritional profile with low-fat content composed mainly of monounsaturated fatty acids, a high source of vegetable protein and dietary fibre, remarkable content of minerals, especially potassium, and an excellent source of vitamins, such as vitamins C and E. A rich composition in terms of phytochemicals, such as tocopherols, carotenoids, and, importantly, phenolic compounds, makes pistachio a powerful food to explore its involvement in the prevention of prevalent pathologies. Although pistachio has been less explored than other nuts (walnut, almonds, hazelnut, etc.), many studies provide evidence of its beneficial effects on CVD risk factors beyond the lipid-lowering effect. The present review gathers recent data regarding the most beneficial effects of pistachio on lipid and glucose homeostasis, endothelial function, oxidative stress, and inflammation that essentially convey a protective/preventive effect on the onset of pathological conditions, such as obesity, type 2 diabetes, CVD, and cancer. Likewise, the influence of pistachio consumption on gut microbiota is reviewed with promising results. However, population nut consumption does not meet current intake recommendations due to the extended belief that they are fattening products, their high cost, or teething problems, among the most critical barriers, which would be solved with more research and information. Keywords: pistachio; prevalent chronic diseases; nuts; nutritional value; health benefits; barriers; facilitator 1. Introduction Nuts are regarded as a relevant source of biologically active components, mainly thanks to their great proportion of unsaturated and essential fatty acids as well as phenolic components [ 1 – 3 ]. In fact, in July 2003, the health claim: “scientific evidence suggests but does not prove that eating 1.5 oz (42.5 g) per day of most nuts, such as pistachios, as part of a diet low in saturated fat and cholesterol may reduce the risk of heart disease”, was ratified by the Food and Drug Administration of United States [4]. Since then, more studies have been carried out to determine the impact of frequent consumption of nuts on our health. Among them, the PREDIMED study [ 5 ] is one of the most valued interventions, which evaluated the effect of a Mediterranean diet supplemented with either 30 g of nuts or olive oil in 7447 participants at high risk of cardiovascular disease (CVD) in comparison to the control diet. Results showed that the Mediterranean diet that included the daily consumption of nuts reduced the risk of suffering a myocardial infarction, stroke, or death from a cardiovascular cause. Thus, improving glycaemic control, lipid levels, blood pressure, obesity biomarkers, and endothelial function, among others, could minimise the risk of suffering CVD [ 3 , 6 ]. Indeed, in a recent overview, the health benefits of nuts regarding the management of dysmetabolic conditions, such as obesity and type 2 diabetes mellitus (T2DM), closely associated with CVD, have been broadly proven [7]. Nutrients 2022,14, 3207. https://doi.org/10.3390/nu14153207 https://www.mdpi.com/journal/nutrients Nutrients 2022,14, 3207 2 of 21 Regarding the most consumed types of nuts, almonds and walnuts accounted for half of the total tree nut estimated consumption worldwide in 2019 (30% and 20%, respectively), followed by cashews, pistachios and hazelnuts, which accounted for 18%, 15% and 11%, respectively, according to International Nut & Dried Fruits [ 8 ]. Following Europe as the leading consumer, Asia and North America were the second and third largest consuming regions, with similar market shares. In the period 2010–2019, nuts were mainly consumed in highand middle-income economies (56% and 39% of the world share for tree nuts in 2019), while peanuts were mostly consumed in middle-income countries, which represented 91% of the global share [8]. It is worth drawing attention to the pistachio among the nuts. Pistacia vera L. is a plant of the Anacardiaceae family which yields a distinctive green fruit of great gastronomic reputation called pistachio. Its cultivation began in western Asia but later spread to the Mediterranean basin through Iran [ 9 ]. Season 2020/2021 was largely an “on year” and, as a result, global production totalled over 1 million metric tons (in-shell basis), the highest amount of the last decade, representing a 54% increase from the previous year and a 68% increase over the previous 10-year average. The United States was the top supplier, accounting for 47% of the global share. It was the second “on year” in a row for Iran, and Turkey showed an exceptionally high bumper crop. The US, Turkey, and Iran produced 97% of the world’s pistachio. Syria (2%), Greece (1%), and others, such as Italy, Spain, Greece, Tunisia, Afghanistan, China, and Australia, account for the remaining 1% [ 8 ]. Although pistachio has been the least explored nut, there is broad evidence confirming its beneficial health effects and, particularly, its positive contribution to minimizing the risk for CVD [10,11], among other pathologies. Due to the health benefits associated with the intake of nuts, their consumption is promoted as a regular food in most of the food-based dietary guidelines [ 12 ] in the context of a healthy diet. However, the population does not always consume them. For example, the Global Burden of Disease Study 2017 estimated 21 g per day as the optimal intake of nuts and seeds, while their actual consumption barely reached 12% of the recommended level [13]. This review aims to revalue pistachio consumption, the least explored nut but with the same or even more healthy potential than the rest due to its interesting nutritional composition. A review of the studies focused on evaluating the biological properties of pistachio, world consumption, and other uses will be developed. In addition, barriers and facilitators of pistachio consumption will be analysed to understand why the dietary requirements for nut consumption are not being met, attempting to shed light and help make it happen. 2. Nutritional Value of Pistachios The pistachio is a low-water (3–6%) and nutritionally rich nut mainly because of its high fat (48–63%) and protein concentration (18–22%), together with the dietary fibre (8–12%; Table 1) [ 14 , 15 ]. In fact, the daily intake of nuts recommended (1.5 oz equivalent to 42.5 g; 4) in the form of pistachios is approximately 15% of the Dietary Reference Intake (DRI) for proteins, 11–18% of DRI for male and female respectively for dietary fibre, and 24% of DRI for fat. Lipids, although present in great amounts, have an equilibrated content of mono- (56–77%) and polyunsaturated (14–33%; Table 1) fatty acids, that may help to reduce LDL-cholesterol and hence the coronary heart disease risk [2,16,17]. Dry roasted pistachios have a lower fat content (45.82 g/100 g) than other nuts (Table 1), mainly monounsaturated fatty acid (24.53 g) followed by polyunsaturated fatty acid ( 13.35 g ) and saturated fatty acid (5.64 g). Of the fatty acids, oleic is the main monounsaturated fatty acid (MUFA) in pistachios followed by linoleic acid (C18:2), which represents more than half of the total fatty acid content (<60 g) (Table 1). Pistachio shows a similar lipid profile to almonds and hazelnuts while walnut fat is headed by linoleic acid (54.0–65.0 g/100 g) followed by oleic (C18:2) and linolenic (C18:3) acids with similar contents. Pistachios are also a worthy source of vegetable protein (about 21%) as almonds Nutrients 2022,14, 3207 3 of 21 (21%), and higher than other nuts, such as hazelnuts and/or walnuts. The amount of total carbohydrates is low to moderate (28%), but pistachios are rich in dietary fibre, mainly insoluble fibre (about 10% versus less than 1% of soluble fibre). Table 1. Composition (g/100 g) in nutrients of dry roasted nuts. Source: USDA National Nutrient Database for Standard Reference (2020). MUFA: monousaturated fatty acids; SFA: saturated fatty acids; PUFA: polyunsaturated fatty acids. g/100 g Pistachio Walnut Almond Hazelnut Water 1.85 4.39 2.41 2.52 Energy (Kcal) 572 643 598 646 Lipids 45.82 60.71 52.54 62.40 SFA 5.64 5.36 4.10 4.51 PUFA 13.35 44.18 12.96 8.46 MUFA 24.53 8.37 33.08 46.61 C16:0 8.0–13.0 6.0–8.0 4.0–13.0 4.0–9.0 C18:0 0.5–2.0 1.0–3.0 2.0–10.0 1.0–4.0 C16:1 0.5–1.0 0.1–0.2 0.2–0.6 0.1–0.3 C18:1 45.0–70.0 13.0–21.0 48.0–80.0 66.0–85.0 C18:2 16.0–37.0 54.0–65.0 15.0–34.0 5.7–25.0 C18:3 0.1–0.4 13.0–14.0 N.D. 0.0–0.2 Proteins 21.05 14.29 20.96 15.03 Carbohydrates 28.28 17.86 21.01 17.60 Fiber 10.30 7.10 10.90 9.40 Sugars 7.74 3.57 4.86 4.89 Pistachio also contains a remarkable content of minerals, such as magnesium, calcium, potassium, and phosphorus, and is documented as an important dietary source of potassium (1025 mg/100 g versus ~700 mg of almond and hazelnut or 450 mg of walnut per 100 g dry roasted nuts). Pistachios are rich in vitamins, especially vitamins C ( 5.60 mg/100 g ) and E (mainly as γ -tocopherol) (2.17 g/100 g). Others, such as vitamin A, vitamin B (except B12), vitamin K, and folate, are existent in pistachios, which could contribute to their respective Recommended Dietary Allowance (RDA). Furthermore, the analysis of phytochemicals in this kind of nut has shown the content of a diversity of bioactive polar and non-polar components, like tocopherols, phytosterols, and phenolics [ 3 , 15 ], reaching the top fifty foods possessing higher antioxidant activity [ 18 ]. Thus, pistachios are the nuts with the highest content of phytosterols compared with the other widely consumed nuts (2790 mg/Kg versus 1990–1130 mg/kg present in walnut, almond, and hazelnut), including β -sitosterol, ∆ 5-avenasterol, campesterol, and stigmasterol [ 19 ]. Pistachio is characterized by its carotenoid content, particularly luteolin and zeaxanthin with an amount of about 2760 µ g/100 g and for β -carotene of about 200 µg/100 g . Compared with hazelnuts, pistachio exhibited 16-fold and eight-fold higher levels of lutein/zeaxanthin and β -carotene, respectively [ 20 ]. Finally, pistachios are also a rich source of phenolic compounds, which will be addressed in a separate section given their nutritional and biological relevance. 3. Antioxidant Phenolic Composition of Pistachios Nutrient databases, like the Phenol-Explorer and the flavonoid and proanthocyanidin databases (USDA) [ 21 , 22 ] report the content of polyphenol of many foods. Furthermore, the concentration of various families of phenolic components in nuts, including pistachio, Nutrients 2022,14, 3207 4 of 21 as well as their antioxidant capacity and evidence for healthy effects have been recently reviewed [1,23]. Walnuts, pecans, and pistachios are the kinds of nuts with the higher phenolic amounts, on the contrary almonds, peanuts, and hazelnut present lower levels (e.g., [ 1 , 23 ]. A varietydependent content of total polar phenolics (TPP) is found in pistachios, ranging from 1600 mg/kg for the Kastel cultivars to more than three times more, 4900 mg/kg for Larnaka. As reported, polar phenolic components can be grouped into different families. Flavanols being the most abundant phenolics found (about 90% of total, from 1500 mg/kg to 4500 mg/kg), whereas the Kastel and Larnaka cultivars showed the lowest and highest concentrations, respectively [ 24 ]. Other families, e.g., anthocyanins (from 54 to 218 mg/kg), flavonols (from 76 to 130 mg/kg), flavanones (from 12 to 71 mg/kg), and gallotannins (from 4 to 46 mg/kg), are also measured. These findings are similar to those reported by Alasalvar & Bolling [1] or Chang et al. [23] (Table 2). Nuts are rather consumed roasted because this operation enhance their color, flavor, and crunchy characteristics. However, roasting conditions may lead to a relevant decrease of the antioxidant capacity in certain nuts (walnut and hazelnut), but in pistachio and almond its activity apparently keeps stable or is modestly improved [ 23 , 25 ]. This effect may be justified by the decrease of phenolics due to effect of heating which is countervailed by the generation of antioxidant-active components formed by the Maillard reactions. Therefore, nuts must be roasted under appropriate settings to keep their great polyphenols content, antioxidant capacity, as well as sensory properties. It is important to highlight that the antioxidant capacity shown by different nuts depends on the type of assay employed. Therefore, it is recommended to use more than one type of antioxidant assay to take into account the different antioxidant mechanism and the restrains of each method [ 26 ]. In fact, various in vitro chemical assays (e.g., ABTS, FRAP, DPPH, ORAC, etc.) and biological methods (generally based on the oxidation of lipoprotein) are employed to measure the antioxidant capacity of nuts [23]. Table 2. Total phenolic content and antioxidant activities of different varieties of pistachios. Type of Pistachio Status of Pistacho TPP Antioxidant Assay Value of Antioxidant Capacity References Larnaka (Spanish cultivar) Natural 4900 mg/Kg fw ORAC 330 mmol of TE/Kg [24] DPPH 35 mmol of TE/Kg Kastel (Spanish cultivar) Natural 1600 mg/Kg fw ORAC 89 mmol of TE/Kg [24] DPPH 13 mmol of TE/Kg Kerman (Spanish cultivar) Natural 1900 mg/Kg fw ORAC 61 mmol of TE/Kg [24] DPPH 10 mmol of TE/Kg Uzun (Turkish cultivar) Natural 26.2 mg/100 g fw DPPH 8.05 µmol of TE/g [27] Roasted 32.4–42.4 mg/100 g fw DPPH 9.76–11.5 µmol of TE/g [27] Ohadi (Turkish cultivar) Natural 9.23–10.55 mg/Kg GAE DPPH 4.34–5.56 mmol TE/Kg [28] ABTS 4.11–5.95 mmol TE/Kg [28] Roasted 10.35–11.23 mg/Kg GAE DPPH 3.53–6.32 mmol TE/Kg [28] ABTS 5.80–7.35 mmol TE/Kg [28] Nutrients 2022,14, 3207 5 of 21 Table 2. Cont. Type of Pistachio Status of Pistacho TPP Antioxidant Assay Value of Antioxidant Capacity References Uzum (Turkish cultivar) Natural 9.19–11.46 mg/Kg GAE DPPH 7.16–13.58 mmol Trolox/Kg [28] ABTS 15.69–28.28 mmol Trolox/Kg [28] Roasted 10.46–12.73 mg/Kg GAE DPPH 13.5–18.00 mmol Trolox/Kg [28] ABTS 26.81–35.86 mmol Trolox/Kg [28] DPPH: 2,2 0 -diphenyl-1-picrylhydrazyl; FRAP: ferric reducing antioxidant power; ABTS: 2,2 0 -azino-bis(3ethylbenzthiazoline-6-sulphonic acid); ORAC: Oxygen radical absorbance capacity; TPP: total polar phenolics; fw: fresh weight; GAE: gallic acid equivalent; TE: trolox equivalent. Regarding the TPP antioxidant activity of pistachios, a wide cultivar-dependent interval was obtained; showing Larnaka the greatest Trolox Equivalent Antioxidant Capacity (TEAC) for both ORAC (330 mmol/kg) and DPPH (35 mmol/kg) methods. On the contrary, Kastel and Kerman are the cultivars with the lowest TEAC data, 89 and 61 mmol/kg (ORAC), and 13 and 10 mmol/kg (DPPH) respectively [ 24 ]. These findings are in agreement with those observed by evaluating the DPPH antioxidant capacity of the Uzun Turkish pistachio cultivar [ 27 , 28 ]. Furthermore, Wu and Prior [ 29 ] created a database concerning ORAC data in foods, giving 76 mmol/kg for pistachio nuts, similar to the value obtained for Kastel and Kerman varieties (Table 2). 4. Health Benefits of Pistachio Consumption Pistachios have an exciting nutritional profile compared with the rest of the nuts due to their lower energy content and highest levels of γ -tocopherol, phytoesterols, carotenoids, minerals, such magnesium and potassium, and vitamins K and B. The nutrients mentioned above undoubtedly contribute to the evidence that the regular intake of pistachios improves health [ 15 ]. Cardiometabolic disease involves dyslipidemia, insulin resistance, hypertension, and excessive visceral fat, which are behind T2DM and CVD [ 30 ]. Epidemiological and/or clinical trials have shown that nut consumption has a positive influence on health, by reducing the risk of suffering CVD [ 15 , 31 , 32 ], hypertension [ 33 ], T2DM [ 34 ] and obesity [ 35 ], among others. These beneficial effects are a consequence of their unique composition since nuts are nutrient-dense foods with healthy MUFA and PUFA fatty acid composition, dietary fibre, high-quality vegetable protein, vitamins, and minerals, along with carotenoids, phytosterols, and phenolic compounds previously described, with recognized benefits to human health [ 3 , 10 , 11 , 36 ]. Regarding pistachio, there is wide evidence confirming its beneficial health effects and, particularly, its positive contribution to minimizing the risk for CVD [10,11]. 4.1. Effects of Pistachio Consumption on Blood Lipids Hyperlipemia is an established risk for CVD. Pistachio intake has been related with the improvement of lipid profile, decreasing total cholesterol (TC) concentration [ 37 – 40 ], TC/high-density lipoprotein (HDL) ratio and low-density lipoprotein (LDL)/HDL ratio [ 37 – 39 , 41 ] in the pistachio-supplemented cluster compared with the control one, in both healthy [ 38 – 40 ] and patients with moderate hypercholesterolemia [ 37 , 41 ]. LDL concentrations also decreased significantly in the pistachio-supplemented group in some studies [ 39 , 40 , 42 ], whereas others observed a non-significant reduction [ 37 , 38 , 43 ]. Additionally, Sheridan et al. [ 41 ] observed a significant increase in circulating HDL concentration in those subjects who consumed pistachios. Recently, a systematic review of epidemiological evidence developed by Lippi et al. [ 44 ] showed the beneficial effects of pistachio intake for improving the blood lipid profile (Figure 1). Nutrients 2022,14, 3207 6 of 21 Nutrients 2022, 14, x FOR PEER REVIEW 6 of 20 diovascular risk. Most interestingly, in a network meta-analysis of clinical trials comparing the effects of different types of tree nut consumption on blood lipids published this year, Liu et al. [46] concluded that diets enriched with pistachio and walnut could be better alternatives for lowering tryglycerides (TGs), LDL cholesterol, and TC compared to other nut-enriched diets. Another conclusion from this study is that more clinical trials are needed to confirm those claims and suggest changes in dietary and nutritional patterns for the ordinary population. Last year, a systematic review and meta-analysis of randomized controlled trials strongly proposed that pistachios may improve lipid profiles (TC, LDL, TG) and protect against cardiometabolic diseases [47]. Early this year, a comprehensive meta-analysis of randomized controlled trials (RCT) studying the effects of nut consumption on blood lipid profile concluded that, although there was no overall effect of nut consumption on lipid profile, pistachio consumption may reduce TC levels [48] (Figure 1). Figure 1. Health benefits of pistachio consumption. 4.2. Effects of Pistachio on Blood Pressure and Endothelial Function Several prospective studies have revealed an inverse relationship between nut consumption and blood pressure (BP) or hypertension. In the particular case of pistachio, a beneficial effect on BP has also been observed in a clinical trial conducted on 28 dyslipidaemic individuals who followed for four weeks either a low-fat control diet, a diet having 10% of the total energy from pistachios, or a diet with 20% of the total energy from pistachios. A significant systolic blood pressure (SBP) reduction was observed, particularly after following the diet supplemented with 10% of the total energy as pistachios, thus, no dose-dependent effect was observed. In addition, no difference in diastolic blood pressure (DBP) was recorded [49]. Another more recent study conducted on T2DM subjects by Sauder et al. [50] showed a decrease in SBP after consuming a diet with 20% energy from pistachios for four weeks. However, three additional controlled feeding trials evaluated the BP lowering effects of pistachios as a secondary outcome and non-significant differences in both SBP and DBP between those subjects supplemented or un-supplemented with pistachios were observed [40,41,51]. Finally, a recent review and meta-analysis of more than 20 RCTs found that despite the intake of mixed nuts may reduce DBP, pistachios seemed to have the most potent effect on reducing both DBP and SBP [33]. Therefore, although there is some evidence that suggests that pistachios may reduce BP the non-consistent results encourage continuing to investigate this aspect (Figure 1). Nuts consumption also improves the endothelial function. The antiatherogenic effect of hazelnut before and after consumption in 21 hypercholesterolemic subjects was investigated. The consumption of a hazelnut-enriched diet (contributing 18–20% of the total Figure 1. Health benefits of pistachio consumption. Clinical trials were developed to study the effect of pistachio consumption on the concentration and size of lipoprotein subclasses (small, medium and large), other blood lipid markers of atherosclerosis different from the classical lipid profile [ 43 , 45 ], found a significant antiatherogenic variation of lipoprotein subclasses. Thus, much evidence suggests that pistachios may improve the blood lipid profile, contributing to decreased cardiovascular risk. Most interestingly, in a network meta-analysis of clinical trials comparing the effects of different types of tree nut consumption on blood lipids published this year, Liu et al. [ 46 ] concluded that diets enriched with pistachio and walnut could be better alternatives for lowering tryglycerides (TGs), LDL cholesterol, and TC compared to other nut-enriched diets. Another conclusion from this study is that more clinical trials are needed to confirm those claims and suggest changes in dietary and nutritional patterns for the ordinary population. Last year, a systematic review and meta-analysis of randomized controlled trials strongly proposed that pistachios may improve lipid profiles (TC, LDL, TG) and protect against cardiometabolic diseases [ 47 ]. Early this year, a comprehensive meta-analysis of randomized controlled trials (RCT) studying the effects of nut consumption on blood lipid profile concluded that, although there was no overall effect of nut consumption on lipid profile, pistachio consumption may reduce TC levels [48] (Figure 1). 4.2. Effects of Pistachio on Blood Pressure and Endothelial Function Several prospective studies have revealed an inverse relationship between nut consumption and blood pressure (BP) or hypertension. In the particular case of pistachio, a beneficial effect on BP has also been observed in a clinical trial conducted on 28 dyslipidaemic individuals who followed for four weeks either a low-fat control diet, a diet having 10% of the total energy from pistachios, or a diet with 20% of the total energy from pistachios. A significant systolic blood pressure (SBP) reduction was observed, particularly after following the diet supplemented with 10% of the total energy as pistachios, thus, no dose-dependent effect was observed. In addition, no difference in diastolic blood pressure (DBP) was recorded [ 49 ]. Another more recent study conducted on T2DM subjects by Sauder et al. [ 50 ] showed a decrease in SBP after consuming a diet with 20% energy from pistachios for four weeks. However, three additional controlled feeding trials evaluated the BP lowering effects of pistachios as a secondary outcome and non-significant differences in both SBP and DBP between those subjects supplemented or un-supplemented with pistachios were observed [ 40 , 41 , 51 ]. Finally, a recent review and meta-analysis of more than 20 RCTs found that despite the intake of mixed nuts may reduce DBP, pistachios seemed to have the most potent effect on reducing both DBP and SBP [ 33 ]. Therefore, although there is some evidence that suggests that pistachios may reduce BP the non-consistent results encourage continuing to investigate this aspect (Figure 1). Nutrients 2022,14, 3207 7 of 21 Nuts consumption also improves the endothelial function. The antiatherogenic effect of hazelnut before and after consumption in 21 hypercholesterolemic subjects was investigated. The consumption of a hazelnut-enriched diet (contributing 18–20% of the total daily energy intake) for four weeks significantly improved flow-mediated dilation (FMD), TC, TG, LDL, and HDL as well oxidized-LDL (oxLDL), C-reactive protein (CRP), and soluble vascular cell adhesion molecule-1 (sVCAM-1) compared with the control diet, confirming the antiatherogenic effect of hazelnut-enriched diets by improving endothelial function, preventing LDL oxidation and inflammatory markers, in addition to their lipid and lipoprotein-lowering effects [ 52 ]. Another study conducted by Katz et al. [ 53 ] evaluated the effects of daily walnut consumption on endothelial function and other cardiac risk biomarkers in 46 overweight adults with visceral obesity. Results revealed that a daily intake of 56 g of walnuts for eight weeks improved endothelial function, without weight gain, by improving FMD compared with the control diet, as well as beneficial trends in SBP and maintenance of anthropometric values. Recently, a review summarized the effects of tree nut and peanut intake on vascular function, excluding FMD. A total of 16 studies were evaluated, although very heterogeneous in terms of dose, length of supplementation, study designs, etc. Conclusions were discrepant. Ten studies provided no significant changes, and six studies (one acute and five chronic studies) informed improvements in at least one measure of vascular function. In summary, nuts have the potential to improve vascular function, but the development of future studies is necessary to expand existing knowledge [54] (Figure 1). Regarding pistachio, Kasliwal et al. [ 55 ] evaluated its effect on vascular health in 60 adults with mild dyslipidemia after consuming 80 g (in-shell) pistachios for 12 weeks. Results showed that usual intake of pistachios not only improved glycaemic and lipid parameters but also produced improvements in vascular stiffness and endothelial function (carotid-femoral and brachial-ankle pulse wave velocity). In a recent meta-analysis of randomized, controlled-feeding clinical studies, Fogacci et al. [ 56 ] reviewed the effect of pistachio on brachial artery diameter and flow-mediated dilatation and suggested a significant effect of pistachios on endothelial reactivity, affecting brachial artery diameter but not flow-mediated dilatation. Recently, a comprehensive review [ 57 ] and several systematic reviews and meta-analyses Ghanavati et al. [ 58 ] demonstrated that pistachio consumption can elicit a beneficial effect on some cardiometabolic risk factors, and Asbaghi et al. [ 59 ] suggest the efficacy of pistachio consumption to reduce SBP. Finally, early this year, in the latest review dealing with the effect of dietary polyphenols on vascular health, Grosso and coworkers concluded that hypertension is counteracted by a plant-based dietary pattern, including pistachio, for example, since no single food is enough to control hypertension [60] (Figure 1). 4.3. Effects of Pistachio on Glucose Metabolism In recent years, animal studies have unequivocally shown the positive effect of pistachio feed on glucose homeostasis in altered situations such as diabetes and metabolic syndrome (MetS). Thus, the consumption of pistachio has favorable effects on avoiding hypertriglyceridemia, hyperglycemia, hypercholesterolemia, and inflammation characteristic of a MetS induced by a fructose overload [61]. Recently, the pistachio extract administered to diabetic rats for three weeks significantly improved the lipid profile, oxidative stress, and inflammation process by reducing lipid peroxidation and increasing total antioxidant capacity [ 62 ]. In the same year, a pistachio hull hydro-alcoholic extract, along with aerobic exercise, improved passive avoidance memory in streptozotocin-induced diabetic rats [ 63 ]. More recently, a pistachio extract also reverted most parameters altered by streptozotocin-induced diabetes in rats; not only markers related to glucose homeostasis, but also those associated to ovary damage and oxidative stress [64]. Several epidemiological studies and clinical trials suggested that the regularity of nut consumption is inversely related to an increased risk of T2DM [ 65 – 70 ], mainly attributed to Nutrients 2022,14, 3207 8 of 21 the relatively high content in dietary fibre, the presence of healthy fats and antioxidants components [ 69 ]. Specifically, the effect of consuming pistachio alone or combined with meals was evaluated on postprandial glycaemia [ 71 , 72 ]. Pistachios consumed alone had a minimal effect on postprandial glycaemia, and when 28, 56, or 84 g of pistachios were taken with a carbohydrate meal attenuated in a dose-dependent manner the glycaemic response [ 71 ]. These authors evaluated pistachio consumption’s acute effects on postprandial glucose and insulin levels in a randomized crossover study conducted on subjects with MetS. Results showed that compared with white bread, pistachio with bread decreased postprandial glycaemia levels and increased glucagon-like peptide levels [ 72 ]. Feng et al. [ 73 ] confirmed the positive effect that 42 g of pistachio had on postprandial glycemic and gut hormone responses in women with gestational diabetes mellitus or gestational impaired glucose tolerance, by inducing significantly lower postprandial glucose, insulin, and gastric inhibitory polypeptide (GIP) but higher glucagon-like peptide-1 (GLP-1) levels compared to 100 g of whole-wheat bread. In a controlled clinical trial, healthy young men were randomly addressed to a Mediterranean diet or a Mediterranean diet where monounsaturated fat content was replaced by pistachios (equivalent to 20% of daily caloric intake) for four weeks. Subjects who followed the Mediterranean diet supplemented with pistachios showed a significant decrease in fasting plasma glucose concentrations as compared to the control [ 40 ]. Following the Mediterranean diet-based nutritional intervention, a study carried out by Melero et al. [ 74 ] confirmed the positive influence on the pregnancy of this dietary pattern by reducing the rate of gestational diabetes mellitus in 600 Spanish women who had to intake about 25–30 g of pistachios at least 3 days a week. Besides, a nutritional clinical trial based on the Mediterranean diet during pregnancy seems to be related with a decrease in the offspring’s hospital admission, especially in women with pre-gestational body mass index (BMI) < 25 kg/m2 [ 75 ]. Later, the consumption of 0, 42, and 70 g/day of pistachios by 70 subjects with MetS for 12 weeks, evidenced a downward trend in blood glucose levels in subjects who adhered to pistachio interventions compared to the control diet, but without reaching significant differences [ 51 ]. A similar study carried out with subjects with MetS randomized to either an unsalted pistachios diet (20% dietary energy) or a control diet for 24 weeks showed a significant decrease in glucose levels but not blood insulin levels [ 76 ]. While Hernandez-Alonso et al. [ 43 ] demonstrated that pistachios have glucoseand insulin-lowering effect in a RCT with 54 pre-diabetic subjects who consumed for four months a pistachio-supplemented diet in comparison with a control diet. The effect of replacing carbohydrate consumption with mixed nut consumption (75 g/d) that included pistachios in 117 T2DM subjects for three months showed a significant decrease in glycated hemoglobin (HbA1c) levels, improving glycaemic control [ 77 ]. Results were similar in a crossover trial with 48 diabetic participants after three months of pistachio consumption [ 78 ]. Interestingly, chronic pistachio consumption reduced oxidative damage to DNA and increased the gene expression of some telomere-associated genes, reversing certain deleterious metabolic consequences of prediabetes [ 79 ]. More recently, pistachio, among other Mediterranean products, has been recommended a promising source of multitarget agents in the treatment of MetS [ 80 ]. Despite the encouraging results reported for glucose metabolism in fasting conditions or postprandial status, additional studies are necessary to test pistachio consumption’s long-term effects on insulin resistance and T2DM prevention and/or control. In a recent systematic review and meta-analysis of pistachio on glycemic control and insulin sensitivity in patients with T2DM, prediabetes and MetS, the authors concluded that pistachio nuts might cause a significant reduction in fasting blood glucose and HOMA-IR (homeostatic model assessment for insulin resistance), although HbA1c and fasting plasma insulin might not significantly improve in patients suffering from or at risk of T2DM [ 81 ]. Finally, a RCT published early this year has reported that a Mediterranean diet with additional extra virgin olive oil and pistachios decreases the occurrence of gestational diabetes mellitus [82] (Figure 1). Nutrients 2022,14, 3207 9 of 21 4.4. Effects of Pistachios on Satiety Regulation and Body-Weight Control Although nuts, including pistachios, are still perceived by the general public to be fattening because of their high-fat content, there are several epidemiological studies that have provided strong evidence that nut consumption is associated with neither weight gain nor an increased risk of obesity [ 83 , 84 ]. Regarding pistachio, Li et al. [ 85 ] evaluated the effects of pistachio snack consumption on body weight and lipid levels in obese participants, which were randomly assigned to consume isocaloric weight reduction diets for 12 weeks with an afternoon snack of either 53 g of salted pistachios or 56 g of salted pretzels. Both groups lost weight, but the pistachio-supplemented group showed a higher BMI reduction than the pretzel-supplemented group. Regarding the already mentioned study of Wang et al., [ 51 ], results showed that the supplementation with pistachios (42 or 70 g/d ) for 12-weeks did not lead to weight gain or an increase in waist-to-hip-ratio in Chinese subjects with MetS. Likewise, Gulati et al. [ 76 ] evaluated the effects of pistachios on body composition in 60 individuals with MetS randomised to either the pistachio (20% dietary energy) or control group for 24 weeks, and no significant differences were detected in body weight, although a significant decrease in waist circumference was observed. However, Parham et al. [ 78 ] found a significant reduction in BMI after 50 g pistachio consumption for 12 weeks compared to the control diet. Other clinical studies where apart from studying the effect of pistachio consumption on biomarkers of cardiovascular health, also evaluated the impact on weight or/and BMI, did not observe differences between participants belonging to the supplemented diet with nuts and the control group [ 38 – 41 ]. A more recent study developed by Fantino et al. [ 86 ], concluded that the daily intake of 44 g pistachios improved quality diet without disturbing body weight in healthy women. While Rock et al. [ 87 ] evaluated the impact of consuming 42 g/d of pistachios by non-diabetic overweight/obese adults assigned to a four-month behavioural weight loss intervention against a similar group without consuming pistachios, observing a similar reduction of weight, BMI, and waist circumference (Figure 1). Among the various explanations of why the consumption of pistachios does not induce overweight, being a very energetic food, is their high satiating power, inefficiency in the absorption of the energy they contain, a possible increment in energy expenditure at rest and an increase in fat oxidation (revised by Tan et al. [ 84 ]). Moreover, the crunchy physical structure of nuts in general, and pistachio in particular, has demonstrated its positive influence on satiety [ 88 ]. In this sense, recently, a randomized controlled pilot study was carried out to assess the effects of a daily pistachio afternoon snack on nextmeal energy intake, satiety and anthropometry in 30 healthy French women were tutored to consume either 56 g of pistachios or 56 g of isoenergetic/equiprotein savoury biscuit as an afternoon snack. Results revealed that both afternoon snacks provided a similar subjective feeling of satiety, and pistachios consumption did not affect body weight or composition [ 89 ]. Lately, pistachio treatment in obese mice fed a high-fat diet showed neuroprotective effects, including decreased brain apoptosis, decreased brain lipid, and oxidative stress with the improvement of mitochondrial function [ 90 ]. A recent metaanalysis of RCTs by Xia et al. [ 91 ] reported that a diet with pistachios reduced BMI and had no significant effects on body weight and waist circumference. Indeed, recent research has focused on pistachio’s applications as a plant-based snack, particularly for appetite control and healthy weight management [92]. Due to the importance of satiety regulation on body-weight control, clinical trials with pistachios need to be carried out in the future to establish this aspect fully. 4.5. Effect of Pistachios on Inflammatory State Chronic low-grade inflammation has been related with insulin resistance, diabetes, atherosclerosis, obesity and MetS. A few research studies have evaluated the effects of nut intake on inflammation with different results. A previous study suggested that a diet supplemented with pistachio improved some inflammation biomarkers in healthy young men; by decreasing serum interleukin 6 but without changing CRP and tumour Nutrients 2022,14, 3207 16 of 21 25. Ojeda-Amador, R.M.; Trapani, S.; Fregapane, G.; Salvador, M.D. Phenolics, tocopherols, and volatiles changes during virgin pistachio oil processing under different technological conditions. Eur. J. Lipid Sci. Technol. 2018,120, 180–221. [CrossRef] 26. Shahidi, F.; Ambigaipalan, P. Phenolics and polyphenolics in foods, beverages and spices: Antioxidant activity and health effects—A review. J. Funct. Foods 2015,18, 820–897. [CrossRef] 27. Rodríguez-Bencomo, J.J.; Kelebek, H.; Sonmezdag, A.S.; Rodríguez-Alcalá, L.M.; Fontecha, J.; Serkan, S. Characterization of the aroma-active, phenolic, and lipid profiles of the pistachio (Pistacia vera L.) nut as affected by the single and double roasting process. J. Agric. Food Chem. 2015,63, 7830–7839. [CrossRef] [PubMed] 28. Sonmezdag, A.S.; Kelebek, H.; Selli, S. Effect of hulling methods and roasting treatment on phenolic compounds and physicochemical properties of cultivars ‘Ohadi’ and ‘Uzun’ pistachios (Pistacia vera L.). Food Chem. 2019 ,272, 418–426. [CrossRef] [PubMed] 29. Wu, X.; Prior, R.L. Identification and characterization of anthocyanins by high-performance liquid chromatography − electrospray ionization − tandem mass spectrometry in common foods in the United States:vegetables, nuts, and grains. J. Agric. Food Chem. 2005,53, 3101–3113. [CrossRef] [PubMed] 30. Guo, F.; Moellering, D.R.; Garvey, W.T. The progression of cardiometabolic disease: Validation of a new cardiometabolic disease staging system applicable to obesity. Obesity 2014,22, 110–118. [CrossRef] 31. Estruch, R.; Ros, E.; Salas-Salvadó, J.; Covas, M.-I.; Corella, D.; Arós, F. Primary prevention of cardiovascular disease with a Mediterranean diet. N. Engl. J. Med. 2013,368, 1279–1290. [CrossRef] 32. Mayhew, A.J.; de Souza, R.J.; Meyre, D.; Anand, S.S.; Mente, A. A systematic review and meta-analysis of nut consumption and incident risk of CVD and all-cause mortality. Br. J. Nutr. 2016,115, 212–225. [CrossRef] 33. Mohammadifard, N.; Salehi-Abargouei, A.; Salas-Salvadó, J.; Guasch-Ferré, M.; Humphries, K.; Sarrafzadegan, N. The effect of tree nut, peanut, and soy nut consumption on blood pressure: A systematic review and meta-analysis of randomized controlled clinical trials. Am. J. Clin. Nutr. 2015,101, 966–982. [CrossRef] 34. Viguiliouk, E.; Kendall, C.W.C.; Blanco Mejia, S.; Cozma, A.I.; Ha, V.; Mirrahimi, A.; Jayalath, V.H.; Augustin, L.S.A.; Chiavaroli, L.; Leiter, L.A.; et al. Effect of tree nuts on glycemic control in diabetes: A systematic review and meta-analysis of randomized controlled dietary trials. PLoS ONE 2014,9, e103376. [CrossRef] 35. Jackson, C.L.; Hu, F.B. Long-term associations of nut consumption with body weight and obesity. Am. J. Clin. Nutr. 2014 ,100, 408–411. [CrossRef] 36. Ta¸s, N.G.; Gökmen, V. Phenolic compounds in natural and roasted nuts and their skins: A brief review. Curr. Opin. Food Sci. 2017 , 14, 103–109. [CrossRef] 37. Edwards, K.; Kwaw, I.; Matud, J.; Kurtz, I. Effect of pistachio nuts on serum lipid levels in patients with moderate hypercholesterolemia. J. Am. Coll. Nutr. 1999,18, 229–232. [CrossRef] [PubMed] 38. Kocyigit, A.; Koylu, A.A.; Keles, H. Effects of pistachio nuts consumption on plasma lipid profile and oxidative status in healthy volunteers. Nutr. Metab. Cardiovasc. Dis. 2006,16, 202–209. [CrossRef] [PubMed] 39. Gebauer, S.K.; West, S.G.; Kay, C.D.; Alaupovic, P.; Bagshaw, D.; Kris-Etherton, P.M. Effects of pistachios on cardiovascular disease risk factors and potential mechanisms of action: A dose-response study. Am. J. Clin. Nutr. 2008 ,88, 651–659. [CrossRef] [PubMed] 40. Sari, I.; Baltaci, Y.; Bagci, C.; Davutoglu, V.; Erel, O.; Celik, H.; Ozer, O.; Aksoy, N.; Aksoy, M. Effect of pistachio diet on lipid parameters, endothelial function, inflammation, and oxidative status: A prospective study. Nutrition 2010 ,26, 399–404. [CrossRef] 41. Sheridan, M.J.; Cooper, J.N.; Erario, M.; Cheifetz, C.E. Pistachio nut consumption and serum lipid levels. J. Am. Coll. Nutr. 2007 , 26, 141–148. [CrossRef] 42. Aldemir, M.; Okulu, E.; Ne¸selio˘glu, S.; Erel, O.; Kayıgil, O. Pistachio diet improves erectile function parameters and serum lipid profiles in patients with erectile dysfunction. Int. J. Impot. Res. 2011,23, 32–38. [CrossRef] 43. Hernandez-Alonso, P.; Baldrich-Mora, M.; Juanola-Falgarona, M.; Bullo, M. Beneficial effect of pistachio consumption on glucose metabolism, insulin resistance, inflammation, and related metabolic risk markers: A randomized clinical trial. Diabetes Care 2014 , 37, 3098–3105. [CrossRef] 44. Lippi, G.; Cervellin, G.; Mattiuzzi, C. More pistachio nuts for improving the blood lipid profile. Systematic review of epidemiological evidence. Acta Biomed. 2016,87, 5–12. 45. Holligan, S.D.; West, S.G.; Gebauer, S.K.; Kay, C.D.; Kris-Etherton, P.M. A moderate-fat diet containing pistachios improves emerging markers of cardiometabolic syndrome in healthy adults with elevated LDL levels. Br. J. Nutr. 2014 ,112, 744–752. [CrossRef] 46. Liu, K.; Hui, S.; Wang, B.; Kaliannan, K.; Guo, X.; Liang, L. Comparative effects of different types of tree nut consumption on blood lipids: A network meta-analysis of clinical trials. Am. J. Clin. Nutr. 2020,111, 219–227. [CrossRef] 47. Hadi, A.; Pourmasoumi, M.; Kazemi, M.; Najafgholizadeh, A.; Marx, W. Efficacy of synbiotic interventions on blood pressure: A systematic review and meta-analysis of clinical trials. Crit. Rev. Food Sci. Nutr. 2022,62, 5582–5591. [CrossRef] [PubMed] 48. Gunathilake, M.; Van, N.T.H.; Kim, J. Effects of nut consumption on blood lipid profile: A meta-analysis of randomized controlled trials. Nutr. Metab. Cardiovasc. Dis. 2022,32, 537–549. [CrossRef] 49. West, S.G.; Gebauer, S.K.; Kay, C.D.; Bagshaw, D.M.; Savastano, D.M.; Diefenbach, C.; Kris-Etherton, P.M. Diets containing pistachios reduce systolic blood pressure and peripheral vascular responses to stress in adults with dyslipidemia. Hypertension 2012,60, 58–63. [CrossRef] [PubMed] Nutrients 2022,14, 3207 17 of 21 50. Sauder, K.A.; McCrea, C.E.; Ulbrecht, J.S.; Kris-Etherton, P.M.; West, S.G. Pistachio nut consumption modifies systemic hemodynamics, increases heart rate variability, and reduces ambulatory blood pressure in well-controlled type 2 diabetes: A randomized trial. J. Am. Heart Assoc. 2014,3, e000873. [CrossRef] 51. Wang, X.; Li, Z.; Liu, Y.; Lv, X.; Yan, W. Effects of pistachios on body weight in Chinese subjects with metabolic syndrome. Nutr. J. 2012,11, 20. [CrossRef] [PubMed] 52. Orem, A.; Balaban Yucesan, F.; Orem, C.; Akcan, B.; Vanizor Kural, B.; Alasalvar, C.; Shahidi, F. Hazelnut-enriched diet improves cardiovascular risk biomarkers beyond a lipid-lowering effect in hypercholesterolemic subjects. J. Clin. Lipidol. 2013 ,7, 123–131. [CrossRef] [PubMed] 53. Katz, D.L.; Davidhi, A.; Yanchou Njike, V. Effects of walnuts on endothelial function in overweight adults with visceral obesity: A randomized, controlled, crossover trial. J. Am. Coll. Nutr. 2012,31, 415–423. [CrossRef] [PubMed] 54. Morgillo, S.; Hill, A.M.; Coates, A.M. The effects of nut consumption on vascular function. Nutrients 2019,11, 116. [CrossRef] 55. Kasliwal, R.R.; Bansal, M.; Mehrotra, R.; Yeptho, K.P.; Trehan, N. Effect of pistachio nut consumption on endothelial function and arterial stiffness. Nutrition 2015,31, 678–685. [CrossRef] 56. Fogacci, F.; Cicero, A.F.G.; Derosa, G.; Rizzo, M.; Veronesi, M.; Borghi, C. Effect of pistachio on brachial artery diameter and flow-mediated dilatation: A systematic review and meta-analysis of randomized, controlled-feeding clinical studies. Crit. Rev. Food Sci. Nutr. 2019,59, 328–335. [CrossRef] 57. Ahmad, R.; Almubayedh, H.; Ahmad, N.; Naqvi, A.A.; Riaz, M. Ethnobotany, ethnopharmacology, phytochemistry, biological activities and toxicity of Pistacia chinensis subsp. integerrima: A comprehensive review. Phytother. Res. 2020 ,34, 2793–2819. [CrossRef] [PubMed] 58. Ghanavati, M.; Rahmani, J.; Clark, C.C.T.; Hosseinabadi, S.M.; Rahimlou, M. Pistachios and cardiometabolic risk factors: A systematic review and meta-analysis of randomized controlled clinical trials. Complement. Ther. Med. 2020 ,52, 102513. [CrossRef] [PubMed] 59. Asbaghi, O.; Hadi, A.; Campbell, M.S.; Venkatakrishnan, K.; Ghaedi, E. Effects of pistachios on anthropometric indices, inflammatory markers, endothelial function and blood pressure in adults: A systematic review and meta-analysis of randomised controlled trials. Br. J. Nutr. 2020,17, 718–729. [CrossRef] [PubMed] 60. Grosso, G.; Godos, J.; Currenti, W.; Micek, A.; Falzone, L.; Libra, M.; Giampieri, F.; Forbes-Hernández, T.Y.; Quiles, J.L.; Battino, M.; et al. The effect of dietary polyphenols on vascular health and hypertension: Current evidence and mechanisms of action. Nutrients 2022,14, 545. [CrossRef] 61. Jamshidi, S.; Hejazi, N.; Golmakani, M.-T.; Tanideh, N. Wild pistachio (Pistacia atlantica mutica) oil improve metabolic syndrome features in rats with high fructose ingestion. Iran J. Basic Med. Sci. 2018,21, 1255–1261. 62. Hosseini, S.; Nili-Ahmadabadi, A.; Nachvak, S.M.; Dastan, D.; Moradi, S.; Abdollahzad, H.; Mostafai, R. Antihyperlipidemic and antioxidative properties of Pistacia atlantica subsp. kurdica in streptozotocin-induced diabetic mice. Diabetes Metab. Syndr. Obes. 2020,13, 1231–1236. [CrossRef] 63. Gorabi, S.A.; Mohammadzadeh, H.; Rostampour, M. The effects of ripe pistachio hulls hydro-alcoholic extract and aerobic training on learning and memory in streptozotocin-induced diabetic male rats. Basic Clin. Neurosci. 2020 ,11, 525–534. [CrossRef] 64. Behmanesh, M.A.; Poormoosavi, S.M.; Pareidar, Y.; Ghorbanzadeh, B.; Mahmoodi-kouhi, A.; Najafzadehvarzi, H. Pistacia atlantica’s effect on ovary damage and oxidative stress in streptozotocin-induced diabetic rats. JBRA Assist. Reprod. 2021 ,25, 28–33. [CrossRef] 65. Jenkins, D.J.A.; Hu, F.B.; Tapsell, L.C.; Josse, A.R.; Kendall, C.W.C. Possible benefit of nuts in type 2 diabetes. J. Nutr. 2008 ,138, 1752S–1756S. [CrossRef] 66. Kochar, J.; Gaziano, J.M.; Djoussé, L. Nut consumption and risk of type II diabetes in the Physicians’ Health Study. Eur. J. Clin. Nutr. 2010,64, 75–79. [CrossRef] 67. Ros, E. Health Benefits of Nut Consumption. Nutrients 2010,2, 652–682. [CrossRef] 68. Damavandi, R.D.; Eghtesadi, S.; Shidfar, F.; Heydari, I.; Foroushani, A.R. Effects of hazelnuts consumption on fasting blood sugar and lipoproteins in patients with type 2 diabetes. J. Res. Med. Sci. 2013,18, 314–321. 69. Pan, A.; Sun, Q.; Manson, J.E.; Willett, W.C.; Hu, F.B. Walnut consumption is associated with lower risk of type 2 diabetes in women. J. Nutr. 2013,143, 512–518. [CrossRef] 70. Pachi, V.K.; Mikropoulou, E.V.; Gkiouvetidis, P.; Siafakas, K.; Argyropoulou, A.; Angelis, A.; Mitakou, S.; Halabalaki, M. Traditional uses, phytochemistry and pharmacology of Chios mastic gum (Pistacia lentiscus var. Chia, Anacardiaceae): A review. J. Ethnopharmacol. 2020,254, 112485. [CrossRef] 71. Kendall, C.W.C.; Josse, A.R.; Esfahani, A.; Jenkins, D.J.A. The impact of pistachio intake alone or in combination with highcarbohydrate foods on post-prandial glycemia. Eur. J. Clin. Nutr. 2011,65, 696–702. [CrossRef] 72. Kendall, C.W.C.; West, S.G.; Augustin, L.S.; Esfahani, A.; Vidgen, E.; Bashyam, B.; Sauder, K.A.; Campbell, J.; Chiavaroli, L.; Jenkins, A.L.; et al. Acute effects of pistachio consumption on glucose and insulin, satiety hormones and endothelial function in the metabolic syndrome. Eur. J. Clin. Nutr. 2014,68, 370–375. [CrossRef] 73. Feng, X.; Liu, H.; Li, Z.; Carughi, A.; Ge, S. Acute effect of pistachio intake on postprandial glycemic and gut hormone responses in women with gestational diabetes or gestational impaired glucose tolerance: A randomized, controlled, crossover study. Front. Nutr. 2019,6, 186. [CrossRef] Nutrients 2022,14, 3207 18 of 21 74. Melero, V.; García de la Torre, N.; Assaf-Balut, C.; Jiménez, I.; del Valle, L.; Durán, A.; Bordiú, E.; Valerio, J.J.; Herraiz, M.A.; Izquierdo, N.; et al. Effect of a Mediterranean diet-based nutritional intervention on the risk of developing gestational diabetes mellitus and other maternal-fetal adverse events in hispanic women residents in Spain. Nutrients 2020,12, 3505. [CrossRef] 75. Melero, V.; Assaf-Balut, C.; De La Torre, N.G.; Jiménez, I.; Bordiú, E.; Del Valle, L.; Valerio, J.; Familiar, C.; Durán, A.; Runkle, I.; et al. Benefits of adhering to a Mediterranean diet supplemented with extra virgin olive oil and pistachios in pregnancy on the health of offspring at 2 years of age. Results of the San Carlos gestational diabetes mellitus prevention study. J. Clin. Med. 2020 ,9, 1454. [CrossRef] 76. Gulati, S.; Misra, A. Sugar Intake, Obesity, and Diabetes in India. Nutrition 2014,30, 192–197. [CrossRef] 77. Jenkins, D.J.A.; Kendall, C.W.C.; Banach, M.S.; Srichaikul. Nuts as a replacement for carbohydrates in the diabetic diet. Diabetes Care 2011,34, 1706–1711. [CrossRef] [PubMed] 78. Parham, M.; Heidari, S.; Khorramirad, A.; Hozoori, M.; Hosseinzadeh, F.; Bakhtyari, L.; Vafaeimanesh, J. Effects of pistachio nut supplementation on blood glucose in patients with type 2 diabetes: A randomized crossover trial. Rev. Diabet. Stud. 2014 ,11, 190–196. [CrossRef] [PubMed] 79. Canudas, S.; Hernández-Alonso, P.; Galié, S.; Muralidharan, J.; Morell-Azanza, L.; Zalba, G.; García-Gavilán, J.; Martí, A.; Salas-Salvadó, J.; Bulló, M. Pistachio consumption modulates DNA oxidation and genes related to telomere maintenance: A crossover randomized clinical trial. Am. J. Clin. Nutr. 2019,109, 1738–1745. [CrossRef] 80. Bagetta, D.; Maruca, A.; Lupia, A.; Mesiti, F.; Catalano, R.; Romeo, I.; Moraca, F.; Ambrosio, F.A.; Costa, G.; Artese, A.; et al. Mediterranean products as promising source of multi-target agents in the treatment of metabolic syndrome. Eur. J. Med. Chem. 2020,186, 111903. [CrossRef] [PubMed] 81. Nowrouzi-Sohrabi, P.; Hassanipour, S.; Sisakht, M.; Daryabeygi-Khotbehsara, R.; Savardashtaki, A.; Fathalipour, M. The effectiveness of pistachio on glycemic control and insulin sensitivity in patients with type 2 diabetes, prediabetes and metabolic syndrome: A systematic review and meta-analysis. Diabetes Metab. Syndr. Clin. Res. Rev. 2020 ,14, 1589–1595. [CrossRef] [PubMed] 82. Assaf-Balut, C.; García de la Torre, N.; Durán, A.; Fuentes, M.; Bordiú, E.; del Valle, L.; Familiar, C.; Ortolá, A.; Jiménez, I.; Herraiz, M.A.; et al. A Mediterranean diet with additional extra virgin olive oil and pistachios reduces the incidence of gestational diabetes mellitus (GDM): A randomized controlled trial: The St. Carlos GDM prevention study. PLoS ONE 2017 ,12, e0185873. [CrossRef] [PubMed] 83. Vadivel, V.; Kunyanga, C.N.; Biesalski, H.K. Health benefits of nut consumption with special reference to body weight control. Nutrition 2012,28, 1089–1097. [CrossRef] 84. Tan, S.Y.; Dhillon, J.; Mattes, R.D. A review of the effects of nuts on appetite, food intake, metabolism, and body weight. Am. J. Clin. Nutr. 2014,100 (Suppl. 1), 412S–422S. [CrossRef] 85. Li, Z.; Song, R.; Nguyen, C.; Zerlin, A.; Karp, H.; Naowamondhol, K. Pistachio nuts reduce triglycerides and body weight by comparison to refined carbohydrate snack in obese subjects on a 12-week weight loss program. J. Am. Coll. Nutr. 2010 ,29, 198–203. [CrossRef] 86. Fantino, M.; Bichard, C.; Mistretta, F.; Bellisle, F. Daily consumption of pistachios over 12 weeks improves dietary profile without increasing body weight in healthy women: A randomized controlled intervention. Appetite 2020,144, 104483. [CrossRef] 87. Rock, C.L.; Zunshine, E.; Nguyen, H.T.; Perez, A.O.; Zoumas, C.; Pakiz, B.; White, M.M. Effects of pistachio consumption in a behavioral weight loss intervention on weight change, cardiometabolic factors, and dietary intake. Nutrients 2020 ,12, 2155. [CrossRef] 88. Cassady, B.A.; Hollis, J.H.; Fulford, A.D.; Considine, R.V.; Mattes, R.D. Mastication of almonds: Effects of lipid bioaccessibility, appetite, and hormone response. Am. J. Clin. Nutr. 2009,89, 794–800. [CrossRef] 89. Carughi, A.; Bellisle, F.; Dougkas, A.; Giboreau, A.; Feeney, M.J.; Higgs, J. A randomized controlled pilot study to assess effects of a daily pistachio (Pistacia vera) afternoon snack on next-meal energy intake, satiety, and anthropometry in French women. Nutrients 2019,11, 767. [CrossRef] 90. Nuzzo, D.; Galizzi, G.; Amato, A.; Terzo, S.; Picone, P.; Cristaldi, L.; Mulè, F.; Di Carlo, M. Regular intake of pistachio mitigates the deleterious effects of a high fat-diet in the brain of obese mice. Antioxidants 2020,9, 317. [CrossRef] 91. Xia, K.; Yang, T.; An, L.-Y.; Lin, Y.-Y.; Qi, Y.-X.; Chen, X.-Z.; Sun, D.-L. The relationship between pistachio (Pistacia vera L) intake and adiposity. A systematic review and meta-analysis of randomized controlled trials. Medicine 2020,99, e21136. [CrossRef] 92. Higgs, J.; Styles, K.; Carughi, A.; Roussell, M.A.; Bellisle, F.; Elsner, W.; Li, Z. Plant-based snacking: Research and practical applications of pistachios for health benefits. J. Nutr. Sci. 2021,10, e87. [CrossRef] 93. Gentile, C.; Perrone, A.; Attanzio, A.; Tesoriere, L.; Livrea, M.A. Sicilian pistachio (Pistacia vera L.) nut inhibits expression and release of inflammatory mediators and reverts the increase of paracellular permeability in IL-1b-exposed human intestinal epithelial cells. Eur. J. Nutr. 2015,54, 811–821. [CrossRef] 94. Ostovan, M.; Bagher Fazljou, S.M.; Khazraei, H.; Araj Khodaei, M.; Torbati, M. The anti-inflammatory effect of Pistacia lentiscus in a rat model of colitis. J. Inflamm. Res. 2020,13, 369–376. [CrossRef] 95. Terzo, S.; Mulè, F.; Caldara, G.F.; Baldassano, S.; Puleio, R.; Vitale, M.; Cassata, G.; Ferrantelli, V.; Amato, A. Pistachio consumption alleviates inflammation and improves gut microbiota composition in mice fed a high-fat diet. Int. J. Mol. Sci. 2020 ,21, 365. [CrossRef] Nutrients 2022,14, 3207 19 of 21 96. Zahouani, Y.; Rhouma, K.B.; Kacem, K.; Sebai, H.; Sakly, M. Aqueous leaf extract of Pistacia lentiscus improves acute acetic acid-induced colitis in rats by reducing inflammation and oxidative stress. J. Med. Food 2021,24, 697–708. [CrossRef] 97. Khedir, S.B.; Mzid, M.; Bardaa, S.; Moalla, D.; Sahnoun, Z.; Rebai, T. In vivo evaluation of the anti-inflammatory effect of Pistacia lentiscus fruit oil and its effects on oxidative stress. Evid. Based Complement. Alternat. Med. 2016,2016, 6108203. [PubMed] 98. Catalani, S.; Palma, F.; Battistelli, S.; Benedetti, S. Oxidative stress and apoptosis induction in human thyroid carcinoma cells exposed to the essential oil from Pistacia lentiscus aerial parts. PLoS ONE 2017,12, e0172138. [CrossRef] [PubMed] 99. Paterniti, I.; Impellizzeri, D.; Cordaro, M.; Siracusa, R.; Bisignano, C.; Gugliandolo, E.; Carughi, A.; Esposito, E.; Mandalari, G.; Cuzzocrea, S. The anti-inflammatory and antioxidant potential of pistachios (Pistacia vera L.) in vitro and in vivo .Nutrients 2017 , 9, 915. [CrossRef] [PubMed] 100. Mohamed, K.; Zine, K.; Fahima, K.; Abdelfattah, E.; Sharifudin, S.M.; Duduku, K. NiO nanoparticles induce cytotoxicity mediated through ROS generation and impairing the antioxidant defense in the human lung epithelial cells (A549): Preventive effect of Pistacia lentiscus essential oil. Toxicol. Rep. 2018,5, 480–488. [CrossRef] [PubMed] 101. Ghzaiel, I.; Zarrouk, A.; Nury, T.; Libergoli, M.; Florio, F.; Hammouda, S.; Menetrier, F.; Avoscan, L.; Yammine, A.; Samadi, M.; et al. Antioxidant properties and cytoprotective effect of Pistacia lentiscus L. seed oil against 7 β -hydroxycholesterol-induced toxicity in C2C12 myoblasts: Reduction in oxidative stress, mitochondrial and peroxisomal dysfunctions and attenuation of cell death. Antioxidants 2021,10, 1772. [CrossRef] [PubMed] 102. Tolooei, M.; Mirzaei, A. Effects of Pistacia atlantica extract on erythrocyte membrane rigidity, oxidative stress, and hepatotoxicity induced by CCl4 in rats. Glob. J. Health Sci. 2015,7, 32–38. [CrossRef] 103. Abidi, A.; Kourda, N.; Feki, M.; Khamsa, S.B. Protective Effect of Tunisian Flaxseed Oil against Bleomycin-Induced Pulmonary Fibrosis in Rats. Nutr. Cancer 2017,69, 490–497. [CrossRef] 104. Chebab, S.; Mekircha, F.; Leghouchi, E. Potential protective effect of Pistacia lentiscus oil against chlorpyrifos-induced hormonal changes and oxidative damage in ovaries and thyroid of female rats. Biomed. Pharmacother. 2017,96, 1310–1316. [CrossRef] 105. Saidi, S.A.; Ncir, M.; Chaaben, R.; Jamoussi, K.; van Pelt, J.; Elfeki, A. Liver injury following small intestinal ischemia reperfusion in rats is attenuated by Pistacia lentiscus oil: Antioxidant and anti-inflammatory effects. Arch. Physiol. Biochem. 2017 ,123, 199–205. [CrossRef] 106. Ammari, M.; Othman, H.; Hajri, A.; Sakly, M.; Abdelmelek, H. Pistacia lentiscus oil attenuates memory dysfunctionand decreases levels of biomarkers of oxidative stress inducedby lipopolysaccharide in rats. Brain Res. Bull. 2018,140, 140–147. 107. Hong, M.Y.; Groven, S.; Marx, A.; Rasmussen, C.; Beidler, J. Anti-inflammatory, antioxidant, and hypolipidemic effects of mixed nuts in atherogenic diet-fed rats. Molecules 2018,23, 3126. [CrossRef] [PubMed] 108. Bagheri, S.; Sarabi, M.M.; Khosravi, P. Effects of Pistacia atlantica on oxidative stress markers and antioxidant enzymes expression in diabetic rats. J. Am. Coll. Nutr. 2019,38, 267–274. [CrossRef] [PubMed] 109. Sauder, K.A.; McCrea, C.E.; Ulbrecht, J.S.; Kris-Etherton, P.M.; West, S.G. Effects of pistachios on the lipid/lipoprotein profile, glycemic control, inflammation, and endothelial function in type 2 diabetes: A randomized trial. Metabolism 2015 ,64, 1521–1529. [CrossRef] [PubMed] 110. Kay, C.D.; Gebauer, S.K.; West, S.G.; Kris-Etherton, P.M. Pistachios Increase Serum Antioxidants and Lower Serum Oxidized-LDL in Hypercholesterolemic Adults. J. Nutr. 2010,140, 1093–1098. [CrossRef] 111. Papada, E.; Forbes, A.; Amerikanou, C.; Torovic, L.; Kalogeropoulos, N.; Tzavara, C.; Triantafillidis, J.K.; Kaliora, A.C. Antioxidative efficacy of a Pistacia lentiscus supplement and its effect on the plasma amino acid profile in inflammatory bowel disease: A randomised, double-blind, placebo-controlled trial. Nutrients 2018,10, 1779. [CrossRef] 112. Rahman, H.S. Phytochemical analysis and antioxidant and anticancer activities of mastic gum resin from Pistacia atlantica subspecies kurdica. Onco Targets Ther. 2018,11, 4559–4572. [CrossRef] 113. Kirollos, F.N.; Elhawary, S.S.; Salama, O.M.; Elkhawas, Y.A. LC-ESI-MS/MS and cytotoxic activity of three Pistacia species. Nat. Prod. Res. 2018,33, 1747–1750. [CrossRef] 114. Pasban-Aliabadi, H. Effects of baneh (Pistacia atlantica) gum on human breast cancer cell line (MCF-7) and its interaction with anticancer drug doxorubicin. Iran. J. Pharm. Res. 2019,18, 1959–1966. 115. Dousti, M.; Sari, S.; Saffari, M.; Kelidari, H.; Asare-Addo, K.; Nokhodchi, A. Loading Pistacia atlantica essential oil in solid lipid nanoparticles and its effect on apoptosis of breast cancer cell line MDA-MB-231. Pharm. Dev. Technol. 2022 ,27, 63–71. [CrossRef] 116. Glei, M.; Ludwig, D.; Lamberty, J.; Fischer, S.; Lorkowski, S.; Schlörmann, W. Chemopreventive potential of raw and roasted pistachios regarding colon carcinogenesis. Nutrients 2017,18, 1368. [CrossRef] 117. Koyuncu, I.; Gönel, A.; Temiz, E.; Karao˘gul, E.; Uyar, Z. Pistachio green hull extract induces apoptosis through multiple signaling pathways by causing oxidative stress on colon cancer cells. Anticancer. Agents Med. Chem. 2021 ,21, 725–737. [CrossRef] [PubMed] 118. Seifaddinipour, M.; Farghadani, R.; Namvar, F.; Bin Mohamad, J.; Muhamad, N.A. In vitro and in vivo anticancer activity of the most cytotoxic fraction of pistachio hull extract in breast cancer. Molecules 2020,25, 1776. [CrossRef] [PubMed] 119. Ostovan, M.; Andabar, M.H.; Khazraei, H.; Bagher Fazljou, S.M.; Khodabandeh, Z.; Shamsdin, S.A.; Araj Khodaei, M.; Torbati, M. The short-term effects of Pistacia lentiscus oil and sesame oil on liver and kidney pathology of rats and human cancer cell lines. Galen Med. J. 2020,9, e2001. [CrossRef] [PubMed] 120. Tabanca, N.; Nalbantsoy, A.; Kendra, P.E.; Demirci, F.; Demirci, B. Chemical characterization and biological activity of the mastic gum essential oils of Pistacia lentiscus var. chia from Turkey. Molecules 2020,25, 2136. [CrossRef] [PubMed] Nutrients 2022,14, 3207 20 of 21 121. Soulaidopoulos, S.; Tsiogka, A.; Chrysohoou, C.; Lazarou, E.; Aznaouridis, K.; Doundoulakis, I.; Tyrovola, D.; Tousoulis, D.; Tsioufis, K.; Vlachopoulos, C.; et al. Overview of chios mastic gum (Pistacia lentiscus) effects on human health. Nutrients 2022 ,14, 590. [CrossRef] 122. Doi, K.; Wei, M.; Kitano, M.; Uematsu, N.; Inoue, M.; Wanibuchi, H. Enhancement of preneoplastic lesion yield by Chios Mastic Gum in a rat liver medium-term carcinogenesis bioassay. Toxicol. Appl. Pharmacol. 2009,234, 135–142. [CrossRef] 123. Janakat, S.; Al-Merie, H. Evaluation of hepatoprotective effect of Pistacia lentiscus,Phillyrea latifolia and Nicotiana glauca.J. Ethnopharmacol. 2002,83, 135–138. [CrossRef] 124. Naghshi, S.; Sadeghian, M.; Nasiri, M.; Mobarak, S.; Asadi, M.; Sadegh, O. Association of total nut, tree nut, peanut, and peanut butter consumption with cancer incidence and mortality: A comprehensive systematic review and dose-response meta-analysis of observational studies. Adv. Nutr. 2021,12, 793–808. [CrossRef] 125. Harandi, H.; Khanamani Falahati-pour, S.K.; Mahmoodi, M.; Faramarz, S.; Maleki, H.; Nasab, F.B.; Shiri, H.; Fooladi, S.; Nematollahi, M.H. Nanoliposomal formulation of pistachio hull extract: Preparation, characterization and anti-cancer evaluation through Bax/Bcl2modulation. Mol. Biol. Rep. 2022,49, 2735–2743. [CrossRef] 126. Ukhanova, M.; Wang, X.; Baer, D.J.; Novotny, J.A.; Fredborg, M.; Mai, V. Effects of almond and pistachio consumption on gut microbiota composition in a randomised cross-over human feeding study. Br. J. Nutr. 2014,111, 2146–2152. [CrossRef] 127. Yanni, A.E.; Mitropoulou, G.; Prapa, I.; Agrogiannis, G.; Kostomitsopoulos, N.; Bezirtzoglou, E.; Kourkoutas, Y.; Karathanos, V.T. Functional modulation of gut microbiota in diabetic rats following dietary intervention with pistachio nuts (Pistacia vera L.). Metabol. Open 2020,7, 100040. [CrossRef] [PubMed] 128. Creedon, A.S.; Hung, E.S.; Berry, S.E.; Whelan, K. Nuts and their effect on gut microbiota, gut function and symptoms in adults: A systematic review and meta-analysis of randomised controlled trials. Nutrients 2020,12, 2347. [CrossRef] [PubMed] 129. Catalán, L.; Alvarez-Orti, M.; Pardo-Giménez, A.; Gómez, R.; Rabadán, A.; Pardo, J.E. Pistachio oil: A review on its Chemical composition, extraction systems, and uses. Eur. J. Lipid Sci. Technol. 2017,119, 1600126. [CrossRef] 130. Ojeda-Amador, R.M.; Fregapane, G.; Salvador, M.D. Composition and properties of virgin pistachio oils and their by-products from different cultivars. Food Chem. 2018,240, 123–130. [CrossRef] [PubMed] 131. Fregapane, G.; Guisantes-Batan, E.; Ojeda-Amador, R.M.; Salvador, M.D. Development of functional edible oils enriched with pistachio and walnut phenolic extracts. Food Chem. 2020,310, 125917. [CrossRef] [PubMed] 132. Fregapane, G.; Cabezas Fernández, C.; Salvador, M.D. Emulsion and Microemulsion Systems to Improve Functional Edible Oils Enriched with Walnut and Pistachio Phenolic Extracts. Foods 2022,11, 1210. [CrossRef] 133. Arribas, C.; Cabellos, B.; Sánchez, C.; Cuadrado, C.; Guillamón, E.; Pedrosa, M.M. The impact of extrusion on the nutritional composition, dietary fiber and in vitro digestibility of gluten-free snacks based on rice, pea and carob flour blends. Food Funct. 2017,18, 3654–3663. [CrossRef] 134. Sanchiz, A.; Pedrosa, M.; Guillamon, E.; Arribas, C.; Cabellos, B.; Linacero, R.; Cuadrado, C. Influence of boiling and autoclave processing on the phenolic content, antioxidant activity and functional properties of pistachio, cashew and chestnut flours. LWT 2019,105, 250–256. [CrossRef] 135. Sethi, S.; Tyagi, S.K.; Anurag, R.K. Plant-Based Milk Alternatives an Emerging Segment of Functional Beverages: A Review. J. Food Sci. Technol. 2016,53, 3408–3423. [CrossRef] 136. Shakerardekani, A.; Karim, R.; Ghazali, H.M.; Chin, N.L. Oxidative Stability of Pistachio (Pistacia vera L.) Paste and Spreads. J. Am. Oil Chem. Soc. 2015,92, 1015–1021. [CrossRef] 137. Polmann, G.; Badia, V.; Danielski, R.; Salvador-Ferreira, S.R.; Block, J.M. Nuts and nut-based products: A meta-analysis from intake health benefits and functional characteristics from recovered constituents. Food Rev. Int. 2022,29, 197–210. [CrossRef] 138. Elloumi, W.; Maalej, A.; Ortiz, S.; Michel, S.; Chamkha, M.; Boutefnouchet, S.; Sayadi, S. Pistacia lentiscus L. Distilled Leaves as a Potential Cosmeceutical Ingredient: Phytochemical Characterization, Transdermal Diffusion, and Anti-Elastase and AntiTyrosinase Activities. Molecules 2022,27, 855. [CrossRef] [PubMed] 139. Kahleova, H.; Levin, S.; Barnard, N.D. Vegetarian Dietary Patterns and Cardiovascular Disease. Prog. Cardiovasc. Dis. 2018 ,61, 54–61. [CrossRef] [PubMed] 140. Neale, E.P.; Tran, G.; Brown, R.C. Barriers and facilitators to nut consumption: A narrative review. Int. J. Environ. Res. Public Health 2020,17, 9127. [CrossRef] 141. Brown, R.C.; Gray, A.R.; Yong, L.C.; Chisholm, A.; Leong, S.L.; Tey, S.L. A comparison of perceptions of nuts between the general public, dietitians, general practitioners, and nurses. Peer J. 2018,6, e5500. [CrossRef] 142. Yong, L.C.; Gray, A.R.; Chisholm, A.; Leong, S.L.; Tey, S.L.; Brown, R.C. Barriers to and facilitators and perceptions of nut consumption among the general population in New Zealand. Public Health Nutr. 2017,20, 3166–3182. [CrossRef] 143. Hong, L.; Yao, L.; Xie, P.; Li, W. An empirical study on consumer purchase intention for nuts and influencing factors—Survey based on consumers from Zhejiang. Food Control 2020,117, 107343. [CrossRef] 144. Tran, G. Investigating the Role of Nutrition Information and Misinformation in Dietetic Practice: A Case Study Exploring the Perceptions of Nut Consumption in Health Professionals and Consumers. Bachelor’s Thesis, University of Wollongong, Wollongong, Australia, 2020. 145. O’Neil, C.E.; Nicklas, T.A. Tree Nut Consumption Is Associated with Better Nutrient Adequacy and Diet Quality in Adults: National Health and Nutrition Examination Survey 2005–2010. Nutrients 2015,7, 595–607. [CrossRef] Nutrients 2022,14, 3207 21 of 21 146. Nikodijevic, C.J.; Probst, Y.C.; Batterham, M.J.; Tapsell, L.C.; Neale, E.P. Nut consumption in a representative survey of Australians: A secondary analysis of the 2011–2012 National Nutrition and Physical Activity Survey. Public Health Nutr. 2020 ,23, 3368–3378. [CrossRef] 147. Brown, R.C.; Tey, S.L.; Gray, A.R.; Chisholm, A.; Smith, C.; Fleming, E.; Blakey, C.; Parnell, W. Patterns and predictors of nut consumption: Results from the 2008/09 New Zealand Adult Nutrition Survey. Br. J. Nutr. 2014,112, 2028–2040. [CrossRef] 148. Dikariyanto, V.; Berry, S.E.; Pot, G.K.; Francis, L.; Smith, L.; Hall, W.L. Tree nut snack consumption is associated with better diet quality and CVD risk in the UK adult population: National Diet and Nutrition Survey (NDNS) 2008–2014. Public Health Nutr. 2020,23, 3160–3169. [CrossRef] [PubMed]