Gene expression profile of peripheral blood cells (PBC) is able to reflect useful aspects of the whole body metabolic status. Therefore, and favored by the huge development of "omic" technologies, blood cells and, particularly, the peripheral blood mononuclear cell (PBMC) fraction, are emerging as a potent source of transcriptomic biomarkers of health and disease. In this review we describe and discuss the available information concerning the use of the PBC and the PBMC fraction as a crucial tool for nutrigenomic studies. Results of these studies reveal, as these cells are good indicators of metabolic adaptations to diet and, moreover, as they allow us to monitor from early stages on, the metabolic alterations associated with dietary imbalances. In this way, blood cells present the capacity of reflecting higher risks of suffering from diet-related pathologies, such as obesity and its medical complications. What is more, different studies also show how PBMC are able to evidence the metabolic recovery associated with weight loss or dietary interventions. Besides, recent research points to the utility of ex vivo systems of blood cells to test the efficacy of food bioactives. All in all, PBC constitutes an easily obtainable source of predictive biomarkers of metabolic imbalance and disease related to diet and obesity, and also of metabolic recovery, which appears as highly relevant for developing nutritional preventive strategies in dietetics. Moreover, they could serve to perform relatively simple and economic in vitro tests to assess food bioactive compounds, promoting in this way functional food research and related industry developments.