Home J Young Pharm. Vol 17/Issue 2/2025 Unveiling the Cardiovascular-Guarding Secrets of Phoenix dactylifera: A Systematic Review

Unveiling the Cardiovascular-Guarding Secrets of Phoenix dactylifera: A Systematic Review

by [email protected]

1Department of Pharmacology, College of Pharmacy, Shaqra University, Al-Dawadmi Campus, Al-Dawadmi, SAUDI ARABIA

2Department of Pharmaceutical Sciences, College of Pharmacy, Shaqra University, Al-Dawadmi Campus, Al-Dawadmi, SAUDI ARABIA

3Department of Pharmacy Practice, College of Pharmacy, Shaqra University, Al-Dawadmi Campus, Al-Dawadmi, SAUDI ARABIA

Corresponding author.

Correspondence: Dr. Thippeswamy Boreddy Shivanandappa Department of Pharmacology, College of Pharmacy, Shaqra University, Al-Dawadmi Campus, Al-Dawadmi-11961, SAUDI ARABIA. Email: [email protected]; [email protected]
Received November 28, 2024; Revised January 12, 2025; Accepted April 13, 2025.
Copyright ©2025 Phcog.Net
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Citation

Published in: Journal of Young Pharmacists, 10 May 2025; 17(2): 250-263. Published online: 10 May 2025DOI: 10.5530/jyp.20251656

ABSTRACT

Cardiovascular disease is a significant cause of global mortality, creating a substantial burden on public health and economy. Research focusing on beneficial food and its active ingredients is essential to mark the health needs. Dates are abundant in polyphenols, particularly flavonoids, micronutrients and dietary fibers, that can influence cardiovascular health and potentially alleviate vascular illness. Based on this, we aimed to systematically review the cardiovascular effects of P. dactylifera. In this study, a systematic-research was performed according to the PRISMA guidelines to collect all relevant studies on “cardio-protective effect of P. dactylifera” using various databases up-to 2024. A total of 109 studies were obtained and evaluated in accordance with pre-selected criteria for inclusion/exclusion and finally 21 studies were included in this review. Evidence from in vitro, in vivo, clinical studies, histological and genetic data indicated that consuming date fruit entirely or its extracts could regulate specific indicators of cardiovascular health, especially level of lipids (triglycerides and cholesterol), markers of inflammation and oxidative stress. Emerging evidence suggest that integrating date fruit and extracts into one’s diet could be a beneficial factor of cardiovasculary healthy life.

Keywords: Cardiovascular disease, Array, Dietary fibres, Polyphenols

 

  1. Ahmed, S., Khan, R. A., & Jamil, S. (2016). Anti hyperlipidemic and hepatoprotective effects of native date fruit variety “Aseel” (Phoenix dactylifera). Pakistan Journal of Pharmaceutical Sciences, 29(6), 1945–1950.
  2. Alalwan, T. A., Perna, S., Mandeel, Q. A., Abdulhadi, A., Alsayyad, A. S., D’Antona, G., Negro, M., Riva, A., Petrangolini, G., Allegrini, P., & Rondanelli, M. (2020). Effects of daily low-dose date consumption on glycemic control, lipid profile and quality of life in adults with pre-and type 2 diabetes: A randomized controlled trial. Nutrients, 12(1), 217. https://doi.org/10.3390/nu12010217
  3. Al-Dashti, Y. A., Holt, R. R., Keen, C. L., & Hackman, R. M. (2021). Date palm fruit (Phoenix dactylifera): Effects on vascular health and future research directions. International Journal of Molecular Sciences, 22(9), 4665. https://doi.org/10.3390/ijms22094665
  4. Alhaider, I. A., Mohamed, M. E., Ahmed, K. K. M., & Kumar, A. H. S. (2017). Date palm (Phoenix dactylifera) fruits as a potential cardioprotective agent: The role of circulating progenitor cells. Frontiers in Pharmacology, 8, 592. https://doi.org/10.3389/fphar.2017.00592
  5. Ali, S. A., Parveen, N., & Ali, A. S. (2018). Links between the Prophet Muhammad (PBUH) recommended foods and disease management: A review in the light of modern superfoods. International Journal of Health Sciences, 12(2), 61–69.
  6. Al-Jaouni, S., Abdul-Hady, S., El-Bassossy, H., Salah, N., & Hagras, M. (2019). Ajwa nanopreparation prevents doxorubicin-associated cardiac dysfunction: Effect on cardiac ischemia and antioxidant capacity. Integrative Cancer Therapies, 18, Article 1534735419862351. https://doi.org/10.1177/1534735419862351
  7. Alsaif, M. A., Khan, L. K., Alhamdan, A. A. H., Alorf, S. M., Harfi, S. H., Al-Othman, A. M., & Arif, Z. (2007). Effect of dates and gahwa (Arabian coffee) supplementation on lipids in hypercholesterolemic hamsters. International Journal of Pharmacology, 3(2), 123–129. https://doi.org/10.3923/ijp.2007.123.129
  8. Al-Yahya, M., Raish, M., AlSaid, M. S., Ahmad, A., Mothana, R. A., Al-Sohaibani, M., Al-Dosari, M. S., Parvez, M. K., & Rafatullah, S. (2016). ‘Ajwa’ dates (Phoenix dactylifera L.) extract ameliorates isoproterenol-induced cardiomyopathy through downregulation of oxidative, inflammatory and apoptotic molecules in rodent model. Phytomedicine, 23(11), 1240–1248. https://doi.org/10.1016/j.phymed.2015.10.019
  9. Amin, H. P., Czank, C., Raheem, S., Zhang, Q., Botting, N. P., Cassidy, A., & Kay, C. D. (2015). Anthocyanins and their physiologically relevant metabolites alter the expression of IL‐6 and VCAM‐1 in CD40L and oxidized LDL challenged vascular endothelial cells. Molecular Nutrition and Food Research, 59(6), 1095–1106. https://doi.org/10.1002/mnfr.201400803
  10. Anwar, S., Raut, R., Alsahli, M. A., Almatroudi, A., Alfheeaid, H., Alzahrani, F. M., Khan, A. A., Allemailem, K. S., Almatroodi, S. A., & Rahmani, A. H. (2022). Role of Ajwa Date Fruit pulp and seed in the management of diseases through in vitro and in silico analysis. Biology, 11(1), Article 78. https://doi.org/10.3390/biology11010078
  11. Arabia, M. A. S. (2006). The famous date varieties in the Kingdom of Saudi Arabia. Ministry of Agriculture (In Arabic, & English).
  12. Asadi-Shekaari, M., Rajabalian, S., Gholamhoseinian, A., Ganjooei, N. A., Hoseini, R., & Mahmoodi, M. (2008). PROTECTIVE EFFECT OF AQUEOUS EXTRACT OF DATE FRUIT against in vitro H2O2-INDUCED CELL DAMAGES. Current Topics in Nutraceutical Research, 6(2).
  13. Barroso, M., Handy, D. E., & Castro, R. (2017). The link between hyperhomocysteinemia and hypomethylation: Implications for cardiovascular disease. Journal of Inborn Errors of Metabolism and Screening, 5, Article e160024. https://doi.org/10.1177/2326409817698994
  14. Benjamin, E. J., Muntner, P., Alonso, A., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Chang, A. R., Cheng, S., Das, S. R., Delling, F. N., Djousse, L., Elkind, M. S. V., Ferguson, J. F., Fornage, M., Jordan, L. C., Khan, S. S., Kissela, B. M., Knutson, K. L., . . . American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. (2019). Heart disease and stroke Statistics-2019 update: A report from the American Heart Association. Circulation, 139(10), e56–e528. https://doi.org/10.1161/CIR.0000000000000659
  15. Besbes, S., Blecker, C., Deroanne, C., Bahloul, N., Lognay, G., Drira, N.-E., & Attia, H. (2004). Date seed oil: Phenolic, tocopherol and sterol profiles. Journal of Food Lipids, 11(4), 251–265. https://doi.org/10.1111/j.1745-4522.2004.01141.x
  16. Borkowski, K., Yim, S. J., Holt, R. R., Hackman, R. M., Keen, C. L., Newman, J. W., & Shearer, G. C. (2019). Walnuts change lipoprotein composition suppressing TNFα-stimulated cytokine production by diabetic adipocyte. The Journal of Nutritional Biochemistry, 68, 51–58. https://doi.org/10.1016/j.jnutbio.2019.03.004
  17. Borochov-Neori, H., Judeinstein, S., Greenberg, A., Volkova, N., Rosenblat, M., & Aviram, M. (2013). Date (Phoenix dactylifera L.) fruit soluble phenolics composition and anti-atherogenic properties in nine Israeli varieties. Journal of Agricultural and Food Chemistry, 61(18), 4278–4286. https://doi.org/10.1021/jf400782v
  18. Boudries, H., Kefalas, P., & Horneromendez, D. (2007). Carotenoid composition of Algerian date varieties (Phoenix dactylifera) at different edible maturation stages. Food Chemistry, 101(4), 1372–1377. https://doi.org/10.1016/j.foodchem.2006.03.043
  19. Bouhlali, E. D. T., Hmidani, A., Bourkhis, B., Moussafir, Z., Filali-Zegzouti, Y., & Alem, C. (2023). Date (Phoenix dactylifera L.) fruits as a potential lipid-lowering therapy: Effect on high-fat diet and triton-WR-1339-Induced hyperlipidemic rats. Drugs and Drug Candidates, 2(2), 422–432. https://doi.org/10.3390/ddc2020021
  20. Cifuentes, F., Palacios, J., Asunción-Alvarez, D., de Albuquerque, R. D. G., Simirgiotis, M. J., Paredes, A., Nwokocha, C. R., Orfali, R., & Perveen, S. (2024). Chemical characterization of Phoenix dactylifera L. Seeds and their beneficial effects on the vascular response in hypertensive rats. Plant Foods for Human Nutrition, 79(2), 337–343. https://doi.org/10.1007/s11130-024-01140-7
  21. Curtis, P. J., van der Velpen, V., Berends, L., Jennings, A., Feelisch, M., Umpleby, A. M., Evans, M., Fernandez, B. O., Meiss, M. S., Minnion, M., Potter, J., Minihane, A.-M., Kay, C. D., Rimm, E. B., & Cassidy, A. (2019). Blueberries improve biomarkers of cardiometabolic function in participants with metabolic syndrome-results from a 6-month, double-blind, randomized controlled trial. The American Journal of Clinical Nutrition, 109(6), 1535–1545. https://doi.org/10.1093/ajcn/nqy380
  22. Djurica, D., Holt, R. R., Ren, J., Shindel, A. W., Hackman, R. M., & Keen, C. L. (2016). Effects of a dietary strawberry powder on parameters of vascular health in adolescent males. The British Journal of Nutrition, 116(4), 639–647. https://doi.org/10.1017/S0007114516002348
  23. El Hadrami, A., & Al-Khayri, J. M. (2012). Socioeconomic and traditional importance of date palm. Emirates Journal of Food and Agriculture, 24(5), 371.
  24. Ezzati, M., & Riboli, E. (2013). Behavioral and dietary risk factors for noncommunicable diseases. The New England Journal of Medicine, 369(10), 954–964. https://doi.org/10.1056/NEJMra1203528
  25. Freemark, M. (2019). Endothelial dysfunction and cardiovascular disease in childhood obesity. Jornal de Pediatria, 95(5), 503–505. https://doi.org/10.1016/j.jped.2018.07.004
  26. Gu, L., Kelm, M. A., Hammerstone, J. F., Beecher, G., Holden, J., Haytowitz, D., & Prior, R. L. (2003). Screening of foods containing proanthocyanidins and their structural characterization using LC-MS/MS and thiolytic degradation. Journal of Agricultural and Food Chemistry, 51(25), 7513–7521. https://doi.org/10.1021/jf034815d
  27. Hamad, I., AbdElgawad, H., Al Jaouni, S., Zinta, G., Asard, H., Hassan, S., Hegab, M., Hagagy, N., & Selim, S. (2015). Metabolic analysis of various date palm fruit (Phoenix dactylifera L.) cultivars from Saudi Arabia to assess their nutritional quality. Molecules, 20(8), 13620–13641. https://doi.org/10.3390/molecules200813620
  28. Hasson, S., Al-Shaqsi, M., Albusaidi, J., Al-Balushi, M., Hakkim, F., Aleemallah, G., & Al-Jabri, A. (2018). Influence of different cultivars of Phoenix dactylifera L.-date fruits on blood clotting and wound healing. Asian Pacific Journal of Tropical Biomedicine, 8(7), 371–376. https://doi.org/10.4103/2221-1691.237081
  29. Hong, Y. J., Tomas-Barberan, F. A., Kader, A. A., & Mitchell, A. E. (2006). The flavonoid glycosides and procyanidin composition of Deglet Noor dates (Phoenix dactylifera). Journal of Agricultural and Food Chemistry, 54(6), 2405–2411. https://doi.org/10.1021/jf0581776
  30. Indrayani, S., Rahmadi, A., Diana, O., & Zeranika, N. (2018). How do Muslims consume dates. Pakistan Journal of Medical and Health Sciences, 12(4), 1732–1743.
  31. Jain, A. K., Mehra, N. K., & Swarnakar, N. K. (2015). Role of antioxidants for the treatment of cardiovascular diseases: Challenges and opportunities. Current Pharmaceutical Design, 21(30), 4441–4455. https://doi.org/10.2174/1381612821666150803151758
  32. James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J., Lackland, D. T., LeFevre, M. L., MacKenzie, T. D., Ogedegbe, O., Smith, S. C., Svetkey, L. P., Taler, S. J., Townsend, R. R., Wright, J. T., Narva, A. S., & Ortiz, E. (2014). 2014 evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the eighth joint national committee (JNC 8). JAMA, 311(5), 507–520. https://doi.org/10.1001/jama.2013.284427
  33. Kehili, H. E., Zerizer, S., Beladjila, K. A., & Kabouche, Z. (2016). Anti-inflammatory effect of Algerian date fruit (Phoenix dactylifera). Food and Agricultural Immunology, 27(6), 820–829. https://doi.org/10.1080/09540105.2016.1183597
  34. Khalid, S., Arshad, M., Saad, B., Imran, M., Bader, H., Bader Ul Ain, H., et al. (2020). Cardioprotective effects of dates, 16, 110–123.
  35. Khan, S. A., Al Kiyumi, A. R., Al Sheidi, M. S., Al Khusaibi, T. S., Al Shehhi, N. M., & Alam, T. (2016). In vitro inhibitory effects on α-glucosidase and α-amylase level and antioxidant potential of seeds of Phoenix dactylifera L. Asian Pacific Journal of Tropical Biomedicine, 6(4), 322–329. https://doi.org/10.1016/j.apjtb.2015.11.008
  36. Kiokias, S., Proestos, C., & Oreopoulou, V. (2018). Effect of natural food antioxidants against LDL and DNA oxidative changes. Antioxidants, 7(10), 133. https://doi.org/10.3390/antiox7100133
  37. Krga, I., Monfoulet, L.-E., Konic-Ristic, A., Mercier, S., Glibetic, M., Morand, C., & Milenkovic, D. (2016). Anthocyanins and their gut metabolites reduce the adhesion of monocyte to TNFα-activated endothelial cells at physiologically relevant concentrations. Archives of Biochemistry and Biophysics, 599, 51–59. https://doi.org/10.1016/j.abb.2016.02.006
  38. Li, X., Xin, Y., Mo, Y., Marozik, P., He, T., & Guo, H. (2022). The bioavailability and biological activities of phytosterols as modulators of cholesterol metabolism. Molecules, 27(2), 523. https://doi.org/10.3390/molecules27020523
  39. Liu, R. H. (2013). Health-promoting components of fruits and vegetables in the diet. Advances in Nutrition, 4(3), 384S–392S. https://doi.org/10.3945/an.112.003517
  40. Lunn, J., & Buttriss, J. L. (2007). Carbohydrates and dietary fibre. Nutrition Bulletin, 32(1), 21–64. https://doi.org/10.1111/j.1467-3010.2007.00616.x
  41. Mahomoodally, M. F., Khadaroo, S. K., Hosenally, M., Zengin, G., Rebezov, M., Ali Shariati, M., et al. (2023). Nutritional, medicinal and functional properties of different parts of the date palm and its fruit (Phoenix dactylifera L.)-A systematic review. Critical Reviews in Food Science and Nutrition, 1–56.
  42. Marques, F. Z., Nelson, E., Chu, P.-Y., Horlock, D., Fiedler, A., Ziemann, M., Tan, J. K., Kuruppu, S., Rajapakse, N. W., El-Osta, A., Mackay, C. R., & Kaye, D. M. (2017). High-fiber diet and acetate supplementation change the gut microbiota and prevent the development of hypertension and heart failure in hypertensive mice. Circulation, 135(10), 964–977. https://doi.org/10.1161/CIRCULATIONAHA.116.024545
  43. Matsuzawa, Y., Kwon, T.-G., Lennon, R. J., Lerman, L. O., & Lerman, A. (2015). Prognostic value of flow-mediated vasodilation in brachial artery and fingertip artery for cardiovascular events: A systematic review and meta-analysis. Journal of the American Heart Association, 4(11), Article e002270. https://doi.org/10.1161/JAHA.115.002270
  44. McGuire, S. (2016). Scientific report of the 2015 dietary guidelines advisory committee. Washington, DC: US Departments of Agriculture and Health and Human Services, 2015. Advances in Nutrition, 7(1), 202–204. https://doi.org/10.3945/an.115.011684
  45. Milenkovic, D., Morand, C., Cassidy, A., Konic-Ristic, A., Tomás-Barberán, F., Ordovas, J. M., Kroon, P., De Caterina, R., & Rodriguez-Mateos, A. (2017). Interindividual variability in biomarkers of cardiometabolic health after consumption of major plant-food bioactive compounds and the determinants involved. Advances in Nutrition, 8(4), 558–570. https://doi.org/10.3945/an.116.013623
  46. Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & PRISMA Group. (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA statement. Annals of Internal Medicine, 151(4), 264–269. https://doi.org/10.7326/0003-4819-151-4-200908180-00135
  47. Morelli, M. B., Gambardella, J., Castellanos, V., Trimarco, V., & Santulli, G. (2020). Vitamin C and cardiovascular disease: An update. Antioxidants, 9(12), 1227. https://doi.org/10.3390/antiox9121227
  48. Mozaffarian, D. (2016). Dietary and policy priorities for cardiovascular disease, diabetes and obesity: A comprehensive review. Circulation, 133(2), 187–225. https://doi.org/10.1161/CIRCULATIONAHA.115.018585
  49. Mubarak, S., Hamid, S. A., Farrag, A. R., Samir, N., & Hussein, J. S. (2018). Cardioprotective effect of date palm against doxorubicin-induced cardiotoxicity. Asian Journal of Pharmaceutical and Clinical Research, 11(7), 141–146. https://doi.org/10.22159/ajpcr.2018.v11i7.24453
  50. Mushtaq, Z., Kausar, S., Kousar, N., & Chiragh, S. (2017). Effect OF AJWA date seed on lipid profile OF diet induced hyperlipidemic rabbits. Khyber Medical University Journal, 9(3), 135–139.
  51. Nasrullah, P. R., Sehar, B., Safdar, M., Fatima, S., Zeb, F., Shah, J., Ali Khan Khalil, A., Ahmed, B., Alsubaie, A. S. R., & Zaman, M. H. (2023). Effect of Ajwa date pits powder (Phoenix dactylifera L.) on body composition, lipid profile and blood pressure in patients with hyperlipidemia: A randomized clinical trial. Avicenna Journal of Phytomedicine, 13(2), 143–152. https://doi.org/10.22038/AJP.2022.21316
  52. Nawaz, L., Grieve, D. J., Muzaffar, H., Iftikhar, A., & Anwar, H. (2024). Methanolic extract of Phoenix dactylifera confers protection against experimental diabetic cardiomyopathy through modulation of glucolipid metabolism and cardiac remodeling. Cells, 13(14), 1196. https://doi.org/10.3390/cells13141196
  53. Oladzad, S., Fallah, N., Mahboubi, A., Afsham, N., & Taherzadeh, M. J. (2021). Date fruit processing waste and approaches to its valorization: A review. Bioresource Technology, 340, Article 125625. https://doi.org/10.1016/j.biortech.2021.125625
  54. Parmenter, B. H., Croft, K. D., Hodgson, J. M., Dalgaard, F., Bondonno, C. P., Lewis, J. R., Cassidy, A., Scalbert, A., & Bondonno, N. P. (2020). An overview and update on the epidemiology of flavonoid intake and cardiovascular disease risk. Food and Function, 11(8), 6777–6806. https://doi.org/10.1039/d0fo01118e
  55. Plantinga, Y., Ghiadoni, L., Magagna, A., Giannarelli, C., Franzoni, F., Taddei, S., & Salvetti, A. (2007). Supplementation with vitamins C and E improves arterial stiffness and endothelial function in essential hypertensive patients. American Journal of Hypertension, 20(4), 392–397. https://doi.org/10.1016/j.amjhyper.2006.09.021
  56. Rock, W., Rosenblat, M., Borochov-Neori, H., Volkova, N., Judeinstein, S., Elias, M., & Aviram, M. (2009). Effects of date (Phoenix dactylifera L., Medjool or Hallawi Variety) consumption by healthy subjects on serum glucose and lipid levels and on serum oxidative status: A pilot study. Journal of Agricultural and Food Chemistry, 57(17), 8010–8017. https://doi.org/10.1021/jf901559a
  57. Saleh, E. A., Tawfik, M. S., & Abu-Tarboush, H. M. (2011). Phenolic contents and antioxidant activity of various date palm (Phoenix dactylifera L.) fruits from Saudi Arabia. Food and Nutrition Sciences, 2011.
  58. Selmani, C., Chabane, D., & Bouguedoura, N. (2017). Ethnobotanical survey of Phoenix dactylifera L. pollen used for the treatment of infertility problems in Algerian oases. African Journal of Traditional, Complementary, and Alternative Medicines, 14(3), 175–186. https://doi.org/10.21010/ajtcam.v14i3.19
  59. Sorkin, B. C., Kuszak, A. J., Williamson, J. S., Hopp, D. C., & Betz, J. M. (2016). The challenge of reproducibility and accuracy in nutrition research: Resources and pitfalls. Advances in Nutrition, 7(2), 383–389. https://doi.org/10.3945/an.115.010595
  60. Staruschenko, A. (2018). Beneficial effects of high potassium: Contribution of renal basolateral K+ channels. Hypertension, 71(6), 1015–1022. https://doi.org/10.1161/HYPERTENSIONAHA.118.10267
  61. Surampudi, P., Enkhmaa, B., Anuurad, E., & Berglund, L. (2016). Lipid lowering with soluble dietary fiber. Current Atherosclerosis Reports, 18(12), 75. https://doi.org/10.1007/s11883-016-0624-z
  62. Taleb, H., Morris, R. K., Withycombe, C. E., Maddocks, S. E., & Kanekanian, A. D. (2016). Date syrup-derived polyphenols attenuate angiogenic responses and exhibits anti-inflammatory activity mediated by vascular endothelial growth factor and cyclooxygenase-2 expression in endothelial cells. Nutrition Research, 36(7), 636–647. https://doi.org/10.1016/j.nutres.2016.02.010
  63. Tang, W. H. W., Kitai, T., & Hazen, S. L. (2017). Gut microbiota in cardiovascular health and disease. Circulation Research, 120(7), 1183–1196. https://doi.org/10.1161/CIRCRESAHA.117.309715
  64. Thompson, L. U., Boucher, B. A., Liu, Z., Cotterchio, M., & Kreiger, N. (2006). Phytoestrogen content of foods consumed in Canada, including isoflavones, lignans and coumestan. Nutrition and Cancer, 54(2), 184–201. https://doi.org/10.1207/s15327914nc5402_5
  65. Threapleton, D. E., Greenwood, D. C., Evans, C. E. L., Cleghorn, C. L., Nykjaer, C., Woodhead, C., Cade, J. E., Gale, C. P., & Burley, V. J. (2013). Dietary fibre intake and risk of cardiovascular disease: Systematic review and meta-analysis. BMJ, 347, Article f6879. https://doi.org/10.1136/bmj.f6879
  66. Virani, S. S., Alonso, A., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Chang, A. R., Cheng, S., Delling, F. N., Djousse, L., Elkind, M. S. V., Ferguson, J. F., Fornage, M., Khan, S. S., Kissela, B. M., Knutson, K. L., Kwan, T. W., Lackland, D. T., . . . American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. (2020). Heart disease and stroke statistics—2020 update: A report from the American Heart Association. Circulation, 141(9), e139–e596. https://doi.org/10.1161/CIR.0000000000000757
  67. Wald, D. S., Law, M., & Morris, J. K. (2002). Homocysteine and cardiovascular disease: Evidence on causality from a meta-analysis. BMJ, 325(7374), 1202. https://doi.org/10.1136/bmj.325.7374.1202
  68. Watson, R. R., Singh, R. B., & Takahashi, T. (2018). The role of functional food security in global health. Academic Press.
  69. Williamson, G., Kay, C. D., & Crozier, A. (2018). The bioavailability, transport and bioactivity of dietary flavonoids: A review from a historical perspective. Comprehensive Reviews in Food Science and Food Safety, 17(5), 1054–1112. https://doi.org/10.1111/1541-4337.12351
  70. Yahaya, S., Omokhudu, C., Abdulahi, M., & Sanusi, M. S. (2015). Phytochemical screening and mineral evaluation of fresh date fruits (Phoenix dactylifera L.) in wet season of Nigeria.
  71. Yahia, E. M. (2011). Postharvest biology and technology of tropical and subtropical fruits: Fundamental issues. Elsevier.
  72. Younas, A., Naqvi, S. A., Khan, M. R., Shabbir, M. A., Jatoi, M. A., Anwar, F., Inam-Ur-Raheem, M., Saari, N., & Aadil, R. M. (2020). Functional food and nutra‐pharmaceutical perspectives of date (Phoenix dactylifera L.) fruit. Journal of Food Biochemistry, 44(9), Article e13332. https://doi.org/10.1111/jfbc.13332