Seafood consumption patterns and methylmercury risk awareness among Saudi adults: a nationwide cross-sectional survey documenting a structural knowledge-behavior gap.

BACKGROUND

Seafood provides essential nutritional benefits but represents the primary dietary route of exposure to methylmercury (MeHg). Population-level evidence linking adult seafood consumption behavior to MeHg risk awareness in Saudi Arabia remains absent. This study aimed to characterize seafood consumption patterns, estimate MeHg hazard recognition, and identify independent predictors of high-risk consumption and mercury risk awareness among Saudi adults.

METHODS

This nationwide cross-sectional survey enrolled 1,021 adults across all 13 Saudi administrative regions (January-April 2026) and used two pre-specified binary logistic regression models-one examining predictors of high-risk seafood consumption (Model 1) and one examining predictors of mercury risk awareness (Model 2).

RESULTS

Regular seafood consumption was reported by 47.4% of participants; only 19.7% identified mercury as a health concern. High-risk consumption, operationalized using FDA/U.S. EPA advisory thresholds and Gulf-region contamination data, was identified in 53.3% of participants (sensitivity range across five alternative definitions: 24.9-70.4%). Women demonstrated higher MeHg-specific awareness (23.6% vs. 16.5%; p = 0.005) and greater food-safety knowledge (1.29 ± 1.91 vs. 0.71 ± 1.42; p < 0.001). Food-safety knowledge strongly predicted mercury awareness (OR = 4.000, 95% CI [3.350-4.777]) but was not associated with consumption behavior (OR = 0.997; p = 0.950). Coastal residence (OR = 3.019), older age (≥50 years: OR = 3.494), female sex (OR = 0.534), and lower educational attainment independently predicted high-risk consumption.

CONCLUSION

Consistent with our objective of evaluating whether food-safety knowledge translates into safer seafood choices, this knowledge-behavior gap was robust across all five sensitivity specifications, confirming a structural-rather than informational-dissociation between awareness and behavior. Species-specific, geographically targeted interventions, rather than general knowledge-based campaigns, are therefore required to reduce the risk of MeHg exposure among Saudi adults.