Introduction 3. Epidemiological aspects 4. Atheroprotective effect of constituents of Brazil nuts 4.1. Dietary intake of Brazil nuts and protection against atherosclerosis 4.2. Dietary fiber and atherosclerosis 4.3. The atheroprotective effect of micronutrients of Brazil nuts 4.3.1. Magnesium (Mg) 4.3.2. Selenium (Se) 4.4. Arginine and other amino acids 4.5. Fatty acids, phytosterols, and sphingolipids 4.6. Tocopherols 4.7. Polyphenols 5. Summary and perspectives 6. Acknowledgements 7. References Atheroprotective effects of Brazil nuts
39© 1996-2020 from the neighborhood states, the so-called Legal Amazon, tend to have a lower concentration of this microelement (2,3). The objective of this review is to update the relationship of dietary intake of Brazil nuts and the mechanistic role of their bioactive compounds against atherosclerosis and cardiovascular disease.
EPIDEMIOLOGICAL ASPECTSThe two oldest studies regarding nuts, recorded in the MEDLINE, are descriptions of Trapa bispinosa and Anacardium occidentale, respectively published in 1927 and 1930 (4,5). Fraser et al. (6) developed the Adventist Health Study and reported that dietary intake of nuts (5 times per week) was associated with a 48% decrease in the risk of mortality from coronary heart disease (6). Six years later, the Nurses' Health Study found that regular intake of nuts diminished the risk of coronary heart disease (CHD) and non-fatal myocardial infarction (7). The PREDIMED study, a Spanish cohort study covering 7,216 men and women, concluded that frequent consumption of Brazil nut (>3 servings per week) reduced overall, cardiovascular, and cancer mortality (8). In some populations, intake of Brazil nuts is frequent (9). Some studies suggested an association between dietary intake of nuts and decreased risk of other cardiovascular diseases, stroke, and possibly type 2 diabetes mellitus (10-12).
ATHEROPROTECTIVE EFFECT OF CONSTITUENTS OF BRAZIL NUTSBrazil nuts are considered very nutritious, since they contain considerable amounts of fiber, macronutrients, micronutrients and bioactive compounds, such as phytosterols, phenolics, and flavonoids (1,13,14). Antioxidant activity Increased expression of nuclear factor E2-related factor (Nrf2) Decrease in reactive oxygen species (ROS) Decrease in reactive nitrogen species Decrease in lipid peroxidation Decrease in DNA peroxidation Decrease in LDL peroxidation Anti-inflammatory activity Decrease in the blood levels of IL-1, IL-6, INF-γ, TNF-α Decrease in vascular inflammation Antidiabetic activity Decrease in blood glucose level Decrease in pancreatic load Anti-atherosclerosis activity Decrease in formation of macrophage foam cells Decrease in atherogenesis Decrease in total amount of cholesterol, triglycerides, and apolipoprotein-A in the blood Improves blood viscosity