Brazil Nuts: Cholesterol and Inflammation

Table of Contents

1. The Fat Profile, Compared With Other Nuts
2. Selenium, Polyphenols and Sterols
3. How Small the Trials Are
4. Trials Measuring Cholesterol and Triglycerides
5. The Brazil Nut Oil Result
6. Oxidized LDL and Fat Oxidation Markers
7. Trials Measuring Inflammation
8. When the Nut Was Very High in Selenium
9. Mixed-Nut Trials and the Wider Nut Evidence
10. Selenium, Fat or Polyphenols? The Hypotheses
11. What Is Not Known
12. Who the Research Raises Cautions For
13. Connections
14. Key Research Papers
15. Featured Videos

The Fat Profile, Compared With Other Nuts

About two thirds of a Brazil nut's weight is fat. USDA FoodData Central lists 67.1 g of fat per 100 g of dried, unblanched Brazil nuts (FDC ID 170569). That fat breaks down as:

• Saturated fat: 16.1 g per 100 g, mainly palmitic acid (9.6 g) and stearic acid (6.2 g).
• Monounsaturated fat: 23.9 g, almost all oleic acid, the main fat in olive oil.
• Polyunsaturated fat: 24.4 g, almost all linoleic acid, an omega-6 fat. The plant omega-3 fat (alpha-linolenic acid) is present only in trace amounts.

The saturated fat figure stands out once Brazil nuts are set beside other common nuts. The table uses USDA FoodData Central values per 100 g. "Saturated share" is saturated fat divided by total fat.

By these USDA figures, Brazil nuts carry the most saturated fat of the nine common nuts, both by weight and as a share of their fat. Macadamias and cashews come next. Two other points from the same entries matter for cholesterol:

• Plant sterols. These are plant molecules shaped like cholesterol that compete with it for absorption in the gut. USDA lists 64 mg of beta-sitosterol, the main plant sterol, per 100 g of Brazil nuts. That is lower than the figure listed for any of the other nuts in the table that report it: 87 mg for walnuts, 102 mg for hazelnuts, 108 mg for macadamias, 113 mg for cashews, 117 mg for pecans, 130 mg for almonds and 198 mg for pistachios.
• Fiber. USDA lists 7.5 g of dietary fiber per 100 g.

A Brazilian laboratory study of Amazonian oils calculated two indexes from the fatty-acid makeup of Brazil nut oil: an atherogenicity index of 0.20 and a thrombogenicity index of 0.42. Both are described as low (Pereira 2019). These indexes are arithmetic on fatty-acid percentages. They are not measurements of what happens in a person's arteries.

On fat alone, then, the Brazil nut does not look like the strongest cholesterol food among nuts. Any cholesterol effect in the trials below has to be read against that.

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Selenium, Polyphenols and Sterols

Three other groups of compounds come up when researchers try to explain Brazil nut results:

• Selenium. Reviews describe Brazil nuts as among the richest known food sources of selenium, alongside useful amounts of magnesium, copper and zinc (Cardoso 2017). Selenium is built into selenoproteins, including the glutathione peroxidases. These enzymes break down peroxides, the reactive molecules that damage fats, including the fats carried in LDL particles.
• Phenolic compounds. A detailed laboratory analysis found flavan-3-ols such as catechin and epicatechin, quercetin and myricetin compounds, gallic acid, ellagic acid and several other phenolic acids in the nut (Vasquez-Rojas 2021).
• Minor fat-soluble compounds. The same analysis found beta-sitosterol, gamma- and alpha-tocopherol (forms of vitamin E) and squalene (Vasquez-Rojas 2021). USDA lists 9.6 mg of gamma-tocopherol and 5.65 mg of alpha-tocopherol per 100 g (FDC 170569).

Most Brazil nut trials give such a small amount, often one nut a day (roughly 5 g), that the fat, fiber and polyphenol doses are tiny. The one nutrient that is not tiny at that dose is selenium. That is why many researchers treat these studies mainly as selenium studies.

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How Small the Trials Are

A 2022 systematic review collected 24 clinical studies of regular Brazil nut eating. Fifteen of the 24 were not randomized. In all of them the nuts were eaten as part of people's normal free-living diet (da Silva 2022). The review reported improved lipid markers in healthy people and in people with obesity, and improved lipid profiles, oxidative stress and inflammation in people on hemodialysis. It also reported conflicting results for a marker of fat oxidation in people with coronary artery disease.

Looking at the individual trials, a few features recur:

• Size. Most trials enrolled between about 30 and 130 people, and some lost a large share of them before the end. The largest trial that included Brazil nuts (388 people) gave them as one third of a mixed-nut portion, and it found no effect on LDL (Bersch-Ferreira 2024).
• No control group. Several studies gave everyone nuts and compared each person before and after. A before-and-after change cannot separate the nut from the season, from diet changes, from the trial itself, or from the natural drift of blood tests back toward average.
• Doses that differ more than tenfold. The selenium supplied ranged from about 227.5 mcg a day (13 g of defatted flour) to about 1,261 mcg a day (one very selenium-rich nut). The same "one nut a day" means very different things in different batches.
• Short follow-up. Trials ran from 30 days to 6 months. None measured heart attacks, strokes or deaths.

Single-meal studies, which measure blood fats in the hours or days after one serving, are sometimes quoted for Brazil nuts. A single meal cannot show what happens over months or years. No single-meal study is among the records verified for this page, so none is described here.

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Trials Measuring Cholesterol and Triglycerides

Defatted Brazil nut flour in treated high cholesterol (Rio de Janeiro)

This randomized, placebo-controlled, double-blind trial enrolled 77 people with high cholesterol and high blood pressure who were already taking cholesterol-lowering drugs. Everyone received personal dietary guidance. One group added 13 g a day of partially defatted Brazil nut flour (about 227.5 mcg of selenium); the other added dyed cassava flour as a placebo. Both were followed for 90 days.

Within the Brazil nut group, total cholesterol fell by an average of 20.5 mg/dL, non-HDL cholesterol by 19.5 mg/dL and apolipoprotein A-1 (the main protein of HDL particles) by 10.2 mg/dL. The ApoB/ApoA-1 ratio did not change. The key point is the comparison between groups: the trial found no statistical difference in serum lipids or blood pressure between the Brazil nut group and the placebo group. The placebo group's free T3, an active thyroid hormone, fell slightly, and its lipoprotein(a) rose. The authors concluded that the flour seemed to help keep T3 levels steady and contributed to lower blood fats (Carvalho 2015). Because the group-versus-group comparison was null, "within-group" changes are the weaker evidence here.

One nut a day in 130 healthy adults (São Paulo)

130 healthy volunteers ate one Brazil nut a day for 8 weeks, then stopped for 8 weeks. Total cholesterol and fasting glucose were lower after the 8 weeks of nuts. There was no separate control group. The study also genotyped people for variants in selenoprotein genes. A variant in the selenoprotein P gene (rs7579) was linked with cholesterol response, with lower levels in people carrying the GG genotype, a result the authors reported at p = 0.053, right at the usual cut-off for chance (Donadio 2018).

One nut a day in people on hemodialysis

Forty people on maintenance hemodialysis (treatment that filters the blood when the kidneys have failed) each received one Brazil nut a day for 3 months. Afterwards, HDL ("good") cholesterol had risen and LDL had fallen significantly. There was no control group; every participant got the nut (Stockler-Pinto 2014). The inflammation results from the same study are below.

One nut a day in people taking statins

Thirty-two patients taking statins, the most common cholesterol-lowering drugs, ate one Brazil nut daily for 3 months, again without a control group. The study's main finding was genetic: variants in the selenoprotein P gene influenced how triglycerides and LDL responded, along with an antioxidant enzyme and creatine kinase, a muscle enzyme (Watanabe 2022). The abstract does not report an overall cholesterol change for the group as a whole.

What these four studies add up to

One placebo-controlled trial with a null between-group result, and three before-and-after studies, two of which suggest the response depends partly on a person's genes. That is suggestive, but it is not the kind of evidence that settles whether Brazil nuts lower cholesterol.

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The Brazil Nut Oil Result

One randomized trial tested the oil on its own. Thirty-one people with metabolic syndrome took 10 mL a day of either Brazil nut oil (15 people) or soybean oil (16 people) for 30 days, with no other change in lifestyle.

• In the Brazil nut oil group, HDL cholesterol fell and triglycerides rose, both significantly. Malondialdehyde, a marker of fat oxidation, also fell.
• In the soybean oil group, total and LDL cholesterol rose.
• Neither oil changed body measurements or blood pressure.

The authors described the blood-fat changes in both groups as undesirable, and the drop in malondialdehyde as the one favourable effect of the Brazil nut oil (Costa e Silva 2019). This was a 30-day study in 31 people, so it cannot say what would happen over a longer period. It does show that the oil, which carries the nut's fat but little of its selenium, did not reproduce the improvements reported in some whole-nut studies. In this trial its effect on HDL and triglycerides ran the other way.

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Oxidized LDL and Fat Oxidation Markers

LDL particles become more harmful to artery walls when their fats are oxidized, so some trials measured oxidized LDL, or markers of fat oxidation in general, instead of LDL itself.

• Crossover trial, 91 people. Ninety-one people with high blood pressure and high cholesterol, average age 62, took part in a randomized, double-blind, placebo-controlled crossover trial. Each person had 12 weeks of 13 g a day of partially defatted Brazil nut granules (about 227.5 mcg of selenium) and 12 weeks of placebo, with a 4-week break in between. During the Brazil nut period, plasma selenium roughly doubled (from 87.0 to 180.6 mcg/L), activity of the antioxidant enzyme glutathione peroxidase 3 (GPx3) rose by 24.8%, and oxidized LDL fell from 66.31 to 60.68 U/L. People with higher GPx3 activity had lower oxidized LDL. The association with 8-epi-PGF2α, another oxidation marker, fell just short of statistical significance (Huguenin 2015). This report and the 77-person flour trial above carry the same trial registration number (NCT01990391).
• Hemodialysis. In the uncontrolled 40-person study, 8-isoprostane (a marker of fat oxidation) and 8-OHdG (a marker of DNA oxidation) fell after 3 months of one nut a day (Stockler-Pinto 2014).
• Brazil nut oil. Malondialdehyde fell in the 30-day oil trial, even though HDL and triglycerides moved the wrong way (Costa e Silva 2019).
• Coronary artery disease, a null result. Thirty-seven patients with coronary artery disease were randomized to one Brazil nut a day (23 people) or no supplement (14 people) for 3 months. Levels of TMAO (trimethylamine N-oxide), a gut-microbe product linked in other research to heart disease, did not change. Glutathione peroxidase activity rose 41% on average in the nut group, but the change was not statistically significant (Coutinho-Wolino 2022).

The systematic review described the evidence on fat oxidation in coronary artery disease as conflicting (da Silva 2022).

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Trials Measuring Inflammation

Inflammation is usually measured through blood proteins. C-reactive protein (CRP) is made by the liver when inflammation is active. Cytokines such as interleukin-6 (IL-6), tumour necrosis factor (TNF) and interleukin-1β are signalling proteins that immune cells use to switch inflammation on.

Hemodialysis: cytokines fell

In the 40-person hemodialysis study, TNF-α and IL-6 in plasma fell significantly after 3 months of one nut a day, while plasma selenium and glutathione peroxidase activity rose (Stockler-Pinto 2014). People on dialysis often have low selenium and high background inflammation, so they may have more room to change. With no control group, though, the study cannot rule out other causes.

Women with overweight or obesity on a calorie-reduced diet

This 8-week controlled trial was not randomized. It allocated 56 women with overweight or obesity to one of two groups, both on a diet 500 kcal a day below their needs. One group ate no nuts. The other ate 8 g of Brazil nuts a day, supplying about 347.2 mcg of selenium. Forty-six women finished. Both groups cut similar amounts of energy; average weight loss was 2.5 kg in the control group and 3.5 kg in the Brazil nut group.

At the end, the Brazil nut group had lower CRP, TNF, IL-1β and IL-8 than the control group, and lower gut permeability on a sugar-absorption test (the lactulose/mannitol ratio). A rise in blood selenium predicted a fall in IL-8. The authors wrote that the effects "seem to be Se status-dependent" (Silveira 2024). The non-random allocation and the slightly different weight loss between groups are both reasons for caution.

The mixed-nut trial

In the San Diego mixed-nut trial, which included Brazil nuts in its blend, CRP showed only a non-significant downward trend (Nora 2023).

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When the Nut Was Very High in Selenium

The trial that most complicates the anti-inflammatory story came from the same research network in São Paulo. Fifty-five women with obesity were randomly assigned to eat one Brazil nut a day or nothing, for 2 months. The nuts used were unusually rich: about 1,261 mcg of selenium per nut. That is roughly three times the 400 mcg daily upper intake level for adults set by the US Institute of Medicine (NIH Office of Dietary Supplements).

None of the women was selenium-deficient at the start. After 2 months, every selenium marker had risen in the nut group. The amount of IL-6, TNF-α, TLR2 and TLR4 in the blood (TLRs are immune receptors that detect threats) did not change. However, the gene activity behind several of these inflammatory signals increased. The control group showed no changes. The authors described this as a possible sign of a pro-inflammatory stimulus from Brazil nuts this high in selenium (Duarte 2019).

A second report from the same trial (54 women, 29 eating nuts) looked at microRNAs, small molecules that help control gene activity. Two of them, miR-454-3p and miR-584-5p, rose after Brazil nut intake (Reis 2019). What that means for cholesterol or inflammation is not yet known.

Put next to the Silveira trial (about 347 mcg a day, lower inflammatory markers) and the hemodialysis study (people who often start low), the Duarte result fits a pattern seen across selenium research. Effects may depend on how much selenium a person already has and how much they get. More is not automatically better, and in people who were already replete, a very high dose went in the unwanted direction on gene activity. Selenium excess is covered in detail on the selenium overload and safety page.

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Mixed-Nut Trials and the Wider Nut Evidence

DICA-NUTS: the largest trial to include Brazil nuts

This multicentre randomized trial in Brazil enrolled 388 adults over 40 who had had a heart attack 2 to 6 months before. Everyone followed a Brazilian cardioprotective diet. Half also received 30 g a day of mixed nuts: 10 g of peanuts, 10 g of cashews and 10 g of Brazil nuts. After 16 weeks, LDL cholesterol did not differ between the groups (difference 3.48 mg/dL, 95% confidence interval −3.45 to 10.41, p = 0.32). Other blood fats, blood-sugar measures and body measurements did not differ either (Bersch-Ferreira 2024). The analysis was adjusted for each person's statin treatment. Still, it is a null result from the largest trial in which Brazil nuts were part of the intervention.

San Diego mixed-nut trial

Twenty-nine adults with overweight or obesity ate either 42.5 g a day of mixed nuts (cashews, almonds, macadamias, Brazil nuts, pecans, pistachios, walnuts and peanuts) or calorie-matched pretzels for 16 weeks. Total cholesterol, LDL, HDL and lipoprotein(a) did not differ between the groups. The nut group had lower body fat percentage and diastolic blood pressure and higher adiponectin, a hormone made by fat tissue. CRP and 8-oxodG, a DNA-oxidation marker, showed non-significant downward trends (Nora 2023).

The evidence for nuts in general

The stronger evidence for nuts and heart health comes from studies of nuts in general, and they were not built around Brazil nuts:

• A meta-analysis of 18 prospective cohort studies found that people who ate the most nuts had a 25% lower risk of dying of cardiovascular disease than those who ate the fewest (summary relative risk 0.75) and a 27% lower risk of dying of coronary heart disease (0.73). The benefit seemed to level off at about 3 servings a week. Tree nuts and peanuts were similarly associated with lower risk (Chen 2017). Cohort studies show associations, not cause and effect.
• The PREDIMED trial assigned 7,447 Spanish adults at high cardiovascular risk to a Mediterranean diet with extra-virgin olive oil, a Mediterranean diet with mixed nuts, or a reduced-fat control diet. Major cardiovascular events were less frequent with the nut-supplemented diet (hazard ratio 0.72). The 2018 re-analysis was published after protocol problems in the randomization were found, and the original 2013 report was withdrawn (Estruch 2018). The abstract does not list which nuts were used.

Where Brazil nuts sit in the pooled lipid analyses

Meta-analyses and network meta-analyses comparing tree nuts on blood lipids have been published. None was among the records verified for this page, so this page makes no claim about how Brazil nuts ranked in them. What can be said from the verified record: Brazil nuts have been tested mostly in small trials, at very small doses and often without controls. That limits how much they can contribute to any pooled estimate. Results for nuts in general do not automatically carry over to a nut whose fat is about a quarter saturated and whose main distinctive nutrient is selenium.

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Selenium, Fat or Polyphenols? The Hypotheses

The explanations below are hypotheses the researchers proposed or that follow from their designs. None has been proven in people.

• Hypothesis 1: selenium protects LDL through glutathione peroxidase. In the 91-person crossover trial, people whose GPx3 activity rose more had lower oxidized LDL (Huguenin 2015). This is an association within one trial, not proof that the enzyme caused the change.
• Hypothesis 2: selenium works through the thyroid. The flour trial's authors started from the idea that thyroid hormones lower atherogenic lipoproteins (the cholesterol-carrying particles that build plaque) and that selenium is needed to activate thyroid hormone. In that trial the placebo group's free T3 fell while the Brazil nut group's did not (Carvalho 2015). The thyroid side is covered on the selenium and thyroid page.
• Hypothesis 3: genes change the response. In two studies, variants in the selenoprotein P gene changed how cholesterol, triglycerides or LDL responded to the same daily nut (Donadio 2018; Watanabe 2022). If this holds up, averages across a group would hide people who respond and people who do not.
• Hypothesis 4: the effect depends on starting selenium and on dose. The authors of the obesity trial linked their anti-inflammatory findings to selenium status (Silveira 2024). The very-high-selenium trial in women who were already replete moved inflammatory gene activity the other way (Duarte 2019).
• Hypothesis 5: the fat itself is not the main actor. Several trials used partially defatted flour or granules and still reported changes, while the one trial of the oil alone saw HDL fall and triglycerides rise (Costa e Silva 2019). Together with the high saturated share, this argues against crediting the nut's fat for the reported lipid benefits. Neither design isolates the fat cleanly, though.
• Hypothesis 6: polyphenols, sterols and tocopherols contribute. These compounds are present (Vasquez-Rojas 2021), but at one nut a day the amounts are small, and no human trial in our set has tested them apart from selenium.

Animal and laboratory work (not evidence in people)

• In healthy rats, a diet that was 5% Brazil nut raised HDL cholesterol compared with control. Both the 5% and 10% diets lowered fat oxidation in plasma (da Silva Costa 2022).
• In rats with surgically reduced kidney function, a 5% Brazil nut diet for 8 weeks reduced the thickening of the heart's left ventricle, lowered a fat-oxidation marker in heart tissue and raised plasma glutathione peroxidase activity. It did not change gene activity of the inflammatory regulator NF-κB or the antioxidant regulator Nrf2 (Menezes 2024).
• In zebrafish, fatty amides made in the laboratory from Brazil nut oil reduced experimentally induced swelling (Quitian-Useche 2021). These are manufactured compounds, not the nut as eaten.

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What Is Not Known

• Hard outcomes. No trial has tested whether eating Brazil nuts changes rates of heart attack, stroke or death.
• Large, controlled, randomized trials of the nut alone. The best-controlled flour trial found no difference from placebo in blood fats (Carvalho 2015). The largest trial that included Brazil nuts used a mix and found no LDL effect (Bersch-Ferreira 2024).
• The right dose, if there is one. Doses ran from about 227.5 to 1,261 mcg of selenium a day. At the top of that range one trial saw a pro-inflammatory signal in gene activity (Duarte 2019). Because selenium per nut varies so widely, "one nut" is not a fixed dose.
• Whether benefits are limited to people who start low in selenium, such as many people on hemodialysis, and whether people who are already replete gain anything.
• The saturated fat question. No trial in our set tested whether the nut's comparatively high saturated fat offsets anything else, at doses larger than a nut or two.
• Blood sugar. Results conflict. Fasting glucose fell in 130 healthy adults (Donadio 2018). In people with type 2 diabetes, fasting glucose rose significantly after 6 months of Brazil nuts, while HbA1c (a three-month average of blood sugar) did not change (Macan 2022).
• Who was studied. Nearly every trial was run in Brazil, in groups with particular conditions such as obesity, dialysis, treated high cholesterol or heart disease. How well the findings carry over to other diets and populations is untested.

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Who the Research Raises Cautions For

• People already eating selenium-rich foods or taking selenium supplements. The US Institute of Medicine's upper intake level for adults is 400 mcg of selenium a day (Institute of Medicine 2000; NIH Office of Dietary Supplements). A single nut in one trial supplied about 1,261 mcg (Duarte 2019).
• People with obesity who are not selenium-deficient. This was the group in which very-high-selenium nuts increased inflammatory gene activity (Duarte 2019).
• People with metabolic syndrome considering Brazil nut oil. In the one trial of the oil, HDL fell and triglycerides rose over 30 days (Costa e Silva 2019).
• People with type 2 diabetes. Fasting glucose rose over 6 months of Brazil nuts in one study (Macan 2022).
• People on dialysis or cholesterol-lowering drugs. These groups were studied, but in small trials, mostly without control groups. Decisions about diet alongside dialysis or medicines belong with a clinician.

Allergy, aflatoxin and selenium-excess findings are covered on the main Brazil nuts page and the selenium overload and safety page.

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Connections

• Nuts — all nut pages
• Brazil Nuts — the main topic page
• Brazil Nuts — Benefits — the hub for these articles
• Selenium and Thyroid
• Selenium Status and Antioxidant Enzymes
• Brain Aging and Cognition
• Selenium Overload and Safety
• Brazil Nuts: Nutrient Profile
• Nut Benefits — the evidence across all nuts
• Peanuts: Heart Health and Mortality
• Almonds: Heart Health and LDL
• Macadamias — the other high-fat nut
• Selenium
• Glutathione Peroxidase
• Cholesterol Management
• Atherosclerosis
• Metabolic Syndrome
• Dialysis and Transplant
• Lipid Panel
• hs-CRP
• Lipoprotein(a)
• Selenium Test
• Cholesterol and Lipoproteins (animation)

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Key Research Papers

1. da Silva A, Silveira BKS, de Freitas BVM, et al. Effects of Regular Brazil Nut (Bertholletia excelsa H.B.K.) Consumption on Health: A Systematic Review of Clinical Trials. Foods (Basel, Switzerland). 2022;11(18). PubMed PMID: 36141050
2. Carvalho RF, Huguenin GV, Luiz RR, et al. Intake of partially defatted Brazil nut flour reduces serum cholesterol in hypercholesterolemic patients--a randomized controlled trial. Nutrition journal. 2015;14:59. PubMed PMID: 26077768
3. Huguenin GV, Oliveira GM, Moreira AS, et al. Improvement of antioxidant status after Brazil nut intake in hypertensive and dyslipidemic subjects. Nutrition journal. 2015;14:54. PubMed PMID: 26022214
4. Donadio JLS, Rogero MM, Guerra-Shinohara EM, et al. SEPP1 polymorphisms modulate serum glucose and lipid response to Brazil nut supplementation. European journal of nutrition. 2018;57(5):1873-1882. PubMed PMID: 28501922
5. Stockler-Pinto MB, Mafra D, Moraes C, et al. Brazil nut (Bertholletia excelsa, H.B.K.) improves oxidative stress and inflammation biomarkers in hemodialysis patients. Biological trace element research. 2014;158(1):105-12. PubMed PMID: 24504745
6. Moriguchi Watanabe L, Bueno AC, de Lima LF, et al. Genetically determined variations of selenoprotein P are associated with antioxidant, muscular, and lipid biomarkers in response to Brazil nut consumption by patients using statins. The British journal of nutrition. 2022;127(5):679-686. PubMed PMID: 33947487
7. Costa E Silva LM, Pereira de Melo ML, Faro Reis FV, et al. Comparison of the Effects of Brazil Nut Oil and Soybean Oil on the Cardiometabolic Parameters of Patients with Metabolic Syndrome: A Randomized Trial. Nutrients. 2019;12(1). PubMed PMID: 31877968
8. Coutinho-Wolino KS, da Cruz BO, Cardozo LFMF, et al. Brazil nut supplementation does not affect trimethylamine-n-oxide plasma levels in patients with coronary artery disease. Journal of food biochemistry. 2022;46(8):e14201. PubMed PMID: 35467017
9. Silveira BKS, Silva AD, Rocha DMUP, et al. Brazil Nut (Bertholletia excelsa H.B.K.) Consumption in Energy-Restricted Intervention Decreases Proinflammatory Markers and Intestinal Permeability of Women with Overweight/Obesity: A Controlled Trial (Brazilian Nuts Study). The Journal of nutrition. 2024;154(9):2670-2679. PubMed PMID: 39025334
10. Duarte GBS, Reis BZ, Rogero MM, et al. Consumption of Brazil nuts with high selenium levels increased inflammation biomarkers in obese women: A randomized controlled trial. Nutrition (Burbank, Los Angeles County, Calif.). 2019;63-64:162-168. PubMed PMID: 31026738
11. Reis BZ, Duarte GBS, Vargas-Mendez E, et al. Brazil nut intake increases circulating miR-454-3p and miR-584-5p in obese women. Nutrition research (New York, N.Y.). 2019;67:40-52. PubMed PMID: 31150916
12. Bersch-Ferreira ÂC, Weschenfelder C, Vieira Machado RH, et al. Effects of mixed nuts as part of a Brazilian Cardioprotective diet on LDL-cholesterol in adult patients after myocardial infarction: a multicenter randomized controlled clinical trial. Nutrition journal. 2024;23(1):118. PubMed PMID: 39354558
13. Nora CL, Zhang L, Castro RJ, et al. Effects of mixed nut consumption on LDL cholesterol, lipoprotein(a), and other cardiometabolic risk factors in overweight and obese adults. Nutrition, metabolism, and cardiovascular diseases : NMCD. 2023;33(8):1529-1538. PubMed PMID: 37263914
14. Macan TP, de Amorim TA, Damiani AP, et al. Brazil nut prevents oxidative DNA damage in type 2 diabetes patients. Drug and chemical toxicology. 2022;45(3):1066-1072. PubMed PMID: 32811197
15. Cardoso BR, Duarte GBS, Reis BZ, et al. Brazil nuts: Nutritional composition, health benefits and safety aspects. Food research international (Ottawa, Ont.). 2017;100(Pt 2):9-18. PubMed PMID: 28888463
16. Vasquez-Rojas WV, Martín D, Miralles B, et al. Composition of Brazil Nut (Bertholletia excels HBK), Its Beverage and By-Products: A Healthy Food and Potential Source of Ingredients. Foods (Basel, Switzerland). 2021;10(12). PubMed PMID: 34945560
17. Pereira E, Ferreira MC, Sampaio KA, et al. Physical properties of Amazonian fats and oils and their blends. Food chemistry. 2019;278:208-215. PubMed PMID: 30583364
18. da Silva Costa N, Almeida PP, Da Cruz BO, et al. Supplementation of diet with Brazil nut modulates body composition, bone parameters, and lipid peroxidation in Wistar rats. Journal of food biochemistry. 2022;46(10):e14294. PubMed PMID: 35762459
19. Menezes AC, Brito ML, Almeida PP, et al. Brazil nuts potential: effects on lipid peroxidation and heart health in nephrectomized rats. Journal of complementary & integrative medicine. 2024;21(3):340-348. PubMed PMID: 39146527
20. Quitian-Useche YF, Sánchez-Ortiz BL, Borges SF, et al. Fatty ethanolamide of Bertholletia excelsa triglycerides (Brazil nuts): anti-inflammatory action and acute toxicity evaluation in Zebrafish (Danio rerio). Inflammopharmacology. 2021;29(5):1519-1537. PubMed PMID: 34498144
21. Chen GC, Zhang R, Martínez-González MA, et al. Nut consumption in relation to all-cause and cause-specific mortality: a meta-analysis 18 prospective studies. Food & function. 2017;8(11):3893-3905. PubMed PMID: 28875220
22. Estruch R, Ros E, Salas-Salvadó J, et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. The New England journal of medicine. 2018;378(25):e34. PubMed PMID: 29897866
23. Institute of Medicine (US) Panel on Dietary Antioxidants and Related Compounds. Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids. 2000. PubMed PMID: 25077263

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