BACKGROUND: Humans are exposed to mercury primarily in its highly toxic form, methyl mercury, which is known to have adverse effects on various organs and systems. The negative impact of mercury exposure on the growth, development, and mental health of children, from infancy to adolescence, is well-documented. However, there are no internationally standardized safe limits for mercury exposure. This study investigated the impact of dietary habits and higher body mass index (BMI) on blood mercury levels in adolescents. METHODS: This study analyzed the data from the 4th Korean National Environmental Health Survey (KoNEHS) 2018-2020. The focus was on 825 middle and high school students aged 13-18 years, whose blood mercury levels were measured. A survey on dietary and lifestyle habits was also conducted. Blood mercury levels were categorized by geometric median values, and associations with overweight status and seafood consumption were examined using a generalized linear model. RESULTS: The geometric mean blood mercury level for the entire sample was 1.37 μg/L, with levels of 1.31 μg/L in normal-weight individuals and 1.43 μg/L in overweight individuals, showing a statistically significant difference between the two groups. After adjusting for other variables, blood mercury levels were significantly associated with overweight status (estimate: 0.084
p = 0.018
95% confidence interval [CI]: 0.015-0.153), consumption of large fish and tuna more than once a week (estimate: 0.18
p = 0.001
95% CI: 0.077-0.284), and consumption of fish once a week or more (estimate: 0.147
p = 0.004
95% CI: 0.043-0.250). CONCLUSIONS: In adolescents, a higher BMI and an increased consumption of large fish, tuna, and fish were associated with higher blood mercury levels. Notably, a stronger association was found between large fish consumption and blood mercury levels in the overweight group. These findings suggest the need to moderate seafood consumption and establish more proactive mercury exposure standards for adolescents.