Recent studies have shown that incorporating moderate quantities of walnuts into the recommended cholesterol-lowering diet in the U.S. decreased serum concentrations of total cholesterol in normal American men. To explore whether walnut consumption would also prove effective as part of the Japanese diet, we studied the effects of walnut consumption on serum lipids and blood pressure in Japanese subjects. We randomly assigned 20 men and 20 women to two mixed natural diets, each to be consumed for 4 wk in a crossover design. Both diets conformed to the average Japanese diet (reference diet) and contained identical foods and macronutrients, except that 12.5% of the energy of the walnut diet was derived from walnuts (43-57 g/d) (offset by lesser amounts of fatty foods, meat and visible fat). Total cholesterol concentration was 0.16 mmol/L lower for men (P = 0.05) and 0.21 mmol/L lower for women (P<0.01) when they consumed the walnut diet than when they consumed the reference diet. The LDL cholesterol concentrations were 0.18 mmol/L lower for men (P = 0.13) and 0.22 mmol/L lower for women (P<0.01) when they consumed the walnut diet. The ratio of LDL cholesterol to HDL cholesterol and the apolipoprotein B concentration were also lowered by the walnut diet (P<0.05). Blood pressures did not differ between the walnut and reference diet periods. Incorporating moderate quantities of walnuts into the average Japanese diet while maintaining the intake of total dietary fat and energy decreases serum total cholesterol concentrations and favorably modifies the lipoprotein profile in Japanese, particularly in women.