Paraiba do Sul watershed is one of the most important Brazilian water bodies (5.5 million people depend on the river). It is in a critical environmental situation, polluted by industrial discharges, non-treated urban wastes, and pesticides, which have had cumulatively negative effects. This study analyzes the effects of pollution, with a biomarker approach, by using the invasive fish species, Oreochromis niloticus, as a sentinel species. The approach comprehends a general biomarker of the health of individual fish, the condition factor, a biomarker of genotoxicity, the micronuclei test; and specific biomarkers of contaminant exposure such as metallothionein (MT) and acetylcholinesterase (AChE) activity. The results revealed different effects in fish from diverse locations with varying degrees of pollution. Low AChE activities were found in fish from the region with strong agriculture activity, showing the effects of pesticides. Fish from an industrialized and heavily environmentally degraded area presented high levels of MT and low AChE activities, indicating an intricate polluted condition. It is noteworthy that fish located just upstream of the main water-treatment plant of the metropolitan area Rio de Janeiro presented high levels of MT, showing to be affected by metals. This can be an alert to public health officials. O. niloticus has proven a suitable sentinel species to assess the effects of pollutions in an aquatic system with a complex and serious polluted situation. The present study also shows the usefulness of integrating a set of biomarkers to define the exposure and the effects of anthropogenic inputs among impacted and reference sites in this water body.