Fish intake, mercury, and metabolic syndrome: a review of the literature

  • Tamara Soric Psychiatric Hospital Ugljan, Ugljan, Croatia
  • Ivona Dragičević Omnipharma d.o.o., Zagreb, Croatia
  • Miran Čoklo
Keywords: fish intake, mercury, metabolic syndrome


It is already well established that mercury, as a toxic metal, may induce oxidative stress, inactivate several antioxidant mechanisms, and induce a chronic low-grade inflammation, eventually leading to increased risk for metabolic syndrome development. Even though fish intake is commonly associated with the beneficial effects on health, all fish species contain methylmercury, which may have a toxic effect on the human body. Several studies have reported a higher prevalence of metabolic syndrome among people living in the coastal areas, who usually consume more fish than their inland counterparts. Taking into account the impact of fish intake on mercury concentration, together with that of mercury exposure on metabolic syndrome, the aim of this research was to review the existing scientific data regarding the association of all three factors. To our knowledge, only four studies examined the association between mercury concentration and metabolic syndrome, taking fish intake into account. Three out of four studies indicated that exposure, even to low-dose of mercury is associated with metabolic syndrome or at least some of its components. Two of them determined that total fish intake or the intake of some species containing relatively high levels of methylmercury is a contributing factor for mercury concentration in human body.  For better understanding of this association, it is necessary to obtain larger prospective cohort studies or randomized controlled trails. Further studies should be carried out over a wider geographic area and elucidate all significant contributing exposure sources for mercury levels.


1. Reaven GM. Banting lecture 1988: role of insulin resistance in human disease. Diabetes 1988. 1988;37(12):1595-1607.
2. Hanefeld M, Köhler C. The metabolic syndrome and its epidemiologic dimensions in historical perspective. Z Ärztl Fortbild Qualitätssich. 2002;96(3):183-188.
3. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC, Spertus JA, Costa F. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112(17):2735-2752.
4. O'Neill S, O'Driscoll L. Metabolic syndrome: a closer look at the growing epidemic and its associated pathologies. Obes Rev. 2015;16(1):1-12.
5. International Diabetes Federation. The IDF consensus worldwide definition of the metabolic syndrome. Available from: [Accessed 16th February 2017].
6. Nair A, Jordan M, Watkins S, Washam R, DuClos C, Jones S, Palcic J, Pawlowicz M, Blackmore C. Fish consumption and hair mercury levels in women of childbearing age, Martin County, Florida. Matern Child Healt J. 2014;18(10):2352-2361.
7. Tørris C, Molin M, Cvancarova Småstuen M. Association between fish consumption and metabolic syndrome. A large cross-sectional study from the Norwegian Tromsø Study: Tromsø 4. Diabetol Metab Syndr. 2016;8(1):18-27.
8. Mozaffarian D, Rimm EB. Fish intake, contaminants, and human health: evaluating the risk and the benefits. JAMA. 2006;296(15):1885-1899.
9. Puharic Z, Perasovic J. Is there a difference between properly nourished first grade pupils in the Bjelovar-Bilogora and the Split-Dalmatia counties? Radovi Zavoda za znanstvenoistraživački i umjetnički rad u Bjelovaru. 2013;7:57-70.
10. Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, D'Armiento M, D'Andrea F, Giugliano D. Effect of a mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA. 2004;292(12):1440-1446.
11. Kolcic I, Vorko-Jovic A, Salzer B, Smoljanovic M, Kern J, Vuletic S. Metabolic syndrome in a metapopulation of Croatian island isolates. Croat Med J. 2006;47(4):585-592.
12. Deka R, Narancic NS, Xip H, Turek S, Cubrilo-Turek M, Vrhovski-Hebrang D, Janicijevic B, Tomljenovic A, Szirovicza L, Jin L, Chakraborty R, Rudan P. Metabolic syndrome in an island population of the eastern Adriatic coast of Croatia. Coll Antropol. 2008;32(1):85-91.
13. Kearney J. Food consumption trends and drivers. Philos T Roy Soc B. 2010;365(1554): 2793-2807.
14. Ram CVS, Farmer JA. Metabolic syndrome in South Asians. J Clin Hypertens. 2012;14(8):561-565.
15. Hightower JM, Moore D. Mercury levels in high-end consumers of fish. Environ Health Persp. 2003;111(4):604-608.
16. Genchi G, Sinicropi MS, Carocci A, Lauria G, Catalano A. Mercury exposure and heart diseases. Int J Environ Res Public Health. 2017;14(1):74. doi: 10.3390/ijerph14010074.
17. Sherlock J, Hislop J, Newton D, Topping G, Whittle K. Elevation of mercury in human blood from controlled chronic ingestion of methylmercury in fish. Hum Toxicol. 1984;3(2):117–131.
18. Schober, SE, Sinks TH, Jones RL, Bolger PM, McDowell M, Osterloh J, Garrett ES, Canady RA, Dillon CF, Sun Y, Joseph CB, Mahaffey KR. Blood mercury levels in US children and women of childbearing age, 1999–2000. JAMA. 2003;289(13):1667–1674.
19. Chan HM, Egeland GM. Fish consumption, mercury exposure, and heart diseases. Nutr Rev. 2004;62(2):68-72.
20. Yaginuma-Sakurai K, Shimada M, Ohba T, Nakai K, Suzuki K, Kurokawa N, Kameo S, Satoh H. Assessment of exposure to methylmercury in pregnant Japanese women by FFQ. Public Health Nutr. 2009;12(12):2352–2358.
21. Mozaffarian D. Fish, mercury, selenium and cardiovascular risk: Current evidence and unanswered questions. Int J Environ Res Public Health. 2009;6(6):1894–1916.
22. Roman HA, Walsh TL, Coull BA, Dewailly E, Guallar E, Hattis D, Marlen K, Schwartz J, Stern AH, Virtanen JK, Rice G. Evaluation of the cardiovascular effects of methylmercury exposures: Current evidence supports development of the dose-response function for regulatory benefits analysis. Environ Health Perspect. 2011;119(5):607-614.
23. Eom SY, Choi SH, Ahn SJ, Kim DK, Kim DW, Lim JA, Choi BS, Shin HJ, Yun SW, Yoon HJ, Kim YM, Hong YS, Yun YW, Sohn SJ, Kim H, Park KS, Pyo HS, Kim H, Oh SY, Kim J, Lee SA, Ha M, Kwon HJ, Park JD. Reference levels of blood mercury and association with metabolic syndrome in Korean adults. Int Arch Occup Environ Health. 2014;87(5):501-213.
24. Cho S, Jacobs DRJr, Park K. Population correlates of circulating mercury levels in Korean adults: The Korea National Health and Nutrition Examination Survey IV. BMC Public Health. 2014;14(1):527-536.
25. Garland M, Morris JS, Rosner BA, Stampfer MJ, Spate VL, Baskett CJ, Willett WC, Hunter DJ. Toenail trace element levels as biomarkers: Reproducibility over a 6-year period. Cancer Epidemiol Biomark Prev. 1993;2(5):493–497.
26. Park K, Seo E. Association between Toenail Mercury and Metabolic Syndrome Is Modified by Selenium. Nutrients. 2016;8(7):424-434.
27. Yoshizawa K, Rimm EB, Morris JS, Spate VL, Hsieh CC, Spiegelman D, Stampfer MJ, Willett WC. Mercury and the risk of coronary heart disease in men. N Engl J Med. 2002;347(22);1755–1760.
28. Salonen JT, Seppanen K, Nyyssonen K, Korpela H, Kauhanen J, Kantola M, Tuomilehto J, Esterbauer H, Salonen R. Intake of mercury from fish, lipid peroxidation, and the risk of myocardial infarction and coronary, cardiovascular, and any death in eastern Finnish men. Circulation. 1995;91(3):645–655.
29. Virtanen JK,Voutilainen S, Rissanen TH, Mursu J, Tuomainen TP, Korhonen MJ, Valkonen V, Seppanen K, Laukkanen JA, Salonen JT. Mercury, Fish Oils, and Risk of Acute Coronary Events and Cardiovascular Disease, Coronary Heart Disease, and All-Cause Mortality in Men in Eastern Finland. Arterioscler Thromb Vasc Biol. 2004;25(1):228-233.
30. Passos CJS, Mergler D. Human mercury exposure and adverse health effects in the Amazon: a review. Cad Saude Publica. 2008;24:503–520.
31. Grotto D, Valentini J, Fillion M, Passos CJ, Garcia SC, Mergler D, Barbosa FJr. Mercury exposure and oxidativestress in communities of the Brazilian Amazon. Sci Total Environ. 2010;408(4):806–811.
32. Tinkov AA, Ajsuvakova OP, Skalnaya MG, Popova EV, Sinitskii AI, Nemereshina ON, Gatiatulina ER, Nikonorov AA, Skalny AV. Mercury and metabolic syndrome: a review of experimental and clinical observations. Biometals. 2015;28(2):231-254.
33. Welty FK, Alfaddagh A, Elajami TK. Targeting inflammation in metabolic syndrome. Transl Res. 2016;167(1):257-280.
34. Park SB, Choi SW, Nam AY. Hair tissue mineral analysis and metabolic syndrome. Biol Trace Elem Res. 2009;130(30):218-228.
35. Bautista LE, Stein JH, Morgan BJ, Stanton N, Young T, Nieto FJ. Association of blood and hair mercury with blood pressure and vascular reactivity. WMJ. 2009;108(5):250-252.
36. Choi B, Yeum KJ, Park SJ, Kim KN, Joo NS. Elevated serum ferritin and mercury concentrations are associated with hypertension; analysis of the fourth and fifth Korea National Health and Nutrition Examination Survey (KNHANES IV-2, 3, 2008-2009 and V-1, 2010). Environ Toxicol. 2015;30(1):101-108.
37. Fillion M, Mergler D, Sousa Passos CJ, Larribe F, Lemire M, Guimarães JRD. A preliminary study of mercury exposure and blood pressure in the Brazilian Amazon. Environ Health. 2006;5(1):29-37.
38. Park JS, Yeum KJ, Choi B, Kim YS, Joo NS. Positive correlation of serum HDL cholesterol with blood mercury concentration in metabolic syndrome Korean men (analysis of KNANES 2008-2010, 2013). J Endocrinol Invest. 2016;39(9):1031-1038.
39. Valera B, Dewailly E, Poirier P. Environmental mercury exposure and blood pressure among Nunavik Inuit adults. Hypertension. 2009;54(5):981–986.
40. Choi AL, Weihe P, Budtz-Jørgensen E, Jørgensen PJ, Salonen JT, Tuomainen TP, Murata K, Nielsen HP, Petersen MS, Askham J, Grandjean P. Methylmercury exposure and adverse cardiovascular effects in Faroese whaling men. Environ Health Perspect. 2009;117(3):367–372.
41. Sørensen N, Murata K, Budtz-Jørgensen E, Weihe P, Grandjean P. Prenatal methylmercury exposure as a cardiovascular risk factor at seven years of age. Epidemiology. 1999;10:370–375.
42. Al-Saleh I, Shinwari N, Mashhour A, Mohamed Gel-D, Ghosh MA, Shammasi Z, Al-Nasser A. Cadmium and mercury levels in Saudi women and its possible relationship with hypertension. Biol Trace Elem Res. 2006;112(1):13–29.
43. Johansson N, Basun H, Winblad B, Nordberg M. Relationship between mercury concentration in blood, cognitive performance, and blood pressure, in an elderly urban population. Biometals. 2002;15(2):189–195.
44. Park SK, Lee S, Basu N, Franzblau A. Association of blood and urinary mercury with hypertension in U.S. adults: the NHANES 2003-2006. Environ Res. 2013;123:25-32.
45. Meltzer HM, Mundal HH, Alexander J, Bibow K, Ydersbond TA. Does dietary arsenic and mercury affect cutaneous bleeding time and blood lipids in humans? Biol Trace Elem Res. 1994;46(1):135-153.
46. You CH, Kim BG, Kim JM, Yu SD, Kim YM, Kim RB, Hong YS. Relationship between blood mercury concentration and waist-to-hip ratio in elderly Korean individuals living in coastal areas. J Prev Med Public Health. 2011;44(5):218-225.
47. Hong D, Cho SH, Park SJ, Kim SY, Park SB. Hair mercury level in smokers and its influence on blood pressure and lipid metabolism. Environ Toxicol Pharmacol. 2013;36(1):103-107.
48. Tinkov AA, Skalnaya MG, Demidov VA, Serebryansky EP, Nikonorov AA, Skalny AV. Hair mercury association with selenium, serum lipid spectrum and gamma glutamyl transferase activity in adults. Biol Trace Elem Res. 2014;161(3):255-262.
49. Park K, Seo E. Toenail mercury and dyslipidemia: Interaction with selenium. J Trace Elem Med Biol. 2017;39:43-49.
50. Fan Y, Zhang C, Bu J. Relationship between selected serum metallic elements and obesity in children and adolescent in the U.S. Nutrients. 2017;9(2):104. doi: 10.3390/nu9020104.
51. Kelley DS, Siegel D, Vemuri M, Mackey BE. Docosahexaenoic acid supplementation improves fasting and postprandial lipid profiles in hypertriglyceridemic men. Am J Clin Nutr. 2007;86(2):324–333.
52. Smith KM, Barraj LM, Kantor M, Sahyoun NR. Relationship between fish intake, n-3 fatty acids, mercury and risk markers of CHD (National Health and Nutrition Examination Survey1999–2002). Public Health Nutr. 2009;12(8):1261–1269.
53. Skalnaya MG, Tinkov AA, Demidov VA, Serebryansky EP, Nikonorov AA, Skalny AV. Hair toxic element content in adult men and women in relation to body mass index. Biol Trace Elem Res. 2014;161(1):13-19.
54. Park JS, Ha KH, He K, Kim DJ. Association between blood mercury level and visceral adiposity in adults. Diabetes Metab. 2016;40:e46.
55. Barbosa AC, Jardim W. Dórea JG, Fosberg B, Souza J. Hair mercury speciation as a function of gender, age, and body mass index in inhabitants of the Negro River basin, Amazon, Brazil. Arch Environ Contam Toxicol. 2001;40(3):439-444.
56. Schumacher L, Abbott LC. Effects of methyl mercury exposure on pancreatic beta cell development and function. J Appl Toxicol. 2017;37(1):4-12.
57. Jeppesen C, Valera B, Nielsen NO, Bjerregaard P, Jørgensen ME. Association between whole blood mercury and glucose intolerance among adult Inuit in Greenland. Environ Res. 2015;143:192-197.
58. Kim KN, Park SJ, Choi B, Joo NS. Blood mercury and insulin resistance in nondiabetic Koreans (KNHANES 2008-2010). Yonsei Med J. 2015;56(4):944-950.
59. Moon SS. Association of lead, mercury and cadmium with diabetes in the Korean population: the Korea National Health and Nutrition Examination Survey (KNHANES) 2009-2010. Diabet Med. 2013;30(4):143-148.
60. Moon SS. Additive effect of heavy metals on metabolic syndrome in the Korean population: the Korean National Health and Nutrition Examination Survey (KNHANES) 2009-2010. Endocrine. 2014;46(2):263-271.
61. Isomaa B, Almgren P, Tuomi T, Forsén B, Lahti K, Nissén M, Taskinen MR, Groop L. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care. 2001;24(4):683–689.
62. Bonora E, Targher G, Formentini G, Calcaterra F, Lombardi S, Marini F, Zenari L, Saggiani F, Poli M, Perbellini S, Raffaelli A, Gemma L, Santi L, Bonadonna RC, Muggeo M. The metabolic syndrome is an independent predictor of cardiovascular disease in type 2 diabetic subjects. Prospective data from the Verona Diabetes Complications Study. Diabet Med. 2004;21(1):52–58.
63. McNeill AM, Rosamond WD, Girman CJ, Golden SH, Schmidt MI, East HE, Ballantyne CM, Heiss G. The metabolic syndrome and 11-year risk of incident cardiovascular disease in the atherosclerosis risk in communities study. Diabetes Care. 2005;28(2):385–390.
64. Ahlqwist M, Bengtsson C, Lapidus L, Gergdahl IA, Schütz A. Serum mercury concentration in relation to survival, symptoms,and diseases: results from the prospective population study of women in Gothenburg, Sweden. Acta Odontol Scand. 1999;57(3):168–174.
65. Hallgren CG, Hallmans G, Jansson JH, Marklund SL, Huhtasaari F, Schütz A, Strömberg U, Vessby B, Skerfving S. Markers of high fish intake are associated with decreased risk of a first myocardial infarction. Br J Nutr. 2001;86(03):397–404.
66. König A, Bouzan C, Cohen JT, Connor WE, Kris-Etherton PM, Gray GM, Lawrence RS, Savitz DA, Teutsch SM. A quantitative analysis of fish consumption and coronary heart disease mortality. Am J Prev Med. 2005;29(4):335-346.
67. FAO/WHO. Report of the Joint FAO/WHO Expert Consultation on the Risks and Benefits of Fish Consumption. Available from: [Accessed 24th February 2017].
68. Mozaffarian D, Shi P, Morris JS, Spiegelman D, Grandjean P, Siscovick DS, Willett WC, Rimm EB. Mercury exposure and risk of cardiovascular disease in two U.S. cohorts. N Engl J Med. 2011;364(12):1116–1125.
69. Wennberg M, Bergdahl IA, Hallmans G, Norberg M, Lundh T, Skerfving S, Strömberg U, Vessby B, Jansson JH. Fish consumption and myocardial infarction: a second prospective biomarker study from northern Sweden. Am J Clin Nutr. 2011;93(1):27–36.
70. Bergdahl IA, Ahlqwist M, Barregard L, Björkelund C, Blomstrand A, Skerfving S, Sundh V, Wennberg M, Lissner L. Mercury in serum predicts low risk of death and myocardial infarction in Gothenburg women. Int Arch Occup Environ Health. 2013;86(1):71–77.
71. Mahaffey KR, Clickner RP, Jeffries RA. Adult women’s blood mercury concentrations vary regionally in the United States: association with patterns of fish consumption (NHANES1999–2004). Environ Health Perspect. 2009;117(1):47–53.
72. Mahaffey KR. Mercury exposure: medical and public health issues. Trans Am Clin Climatol Assoc. 2005;116:127-153.
73. Kim NY, Ahn SJ, Ryu DY, Choi BS, Kim H, Yu IJ, Park JD. Effect of lifestyles on the blood mercury level in Korean adults. Hum Exp Toxicol. 2012;32(6):591-599.
74. Zaribaf F, Falahi E, Barak F, Heidari M, Keshteli AH, Yazdannik A, Esmaillzadeh A. Fish consumption is inversely associated with the metabolic syndrome. Eur J Clin Nutr. 2014;68(4):474-480.
75. Caldwell KL, Mortensen ME, Jones RL, Caudill SP, Osterloh JD. Total blood mercury concentration in the U.S. population: 1999-2006. Int J Hyg Environ Health. 2009;212(6):588-598.
76. Batáriová A, Spevácková V, Benes B, Cejchanová M, Smíd J, Cerná M. Blood and urine levels of Pb, Cd and Hg in the general population of the Czech Republic and proposed reference values. Int J Hyg Environ Health. 2006;209(4):359–366.
77. Passos CJS, Mergler D, Lemire M, Fillion M, Guimaraes JRD. Fish consumption and bioindicators of inorganic mercury exposure. Sci Total Environ. 2007;373(1):68–76.
78. Reis FM, Sampaio C, Brantes A, Aniceto P, Melim M, Cardoso L, Gabriel C, Simao F, Miguel JP. Human exposure to heavy metals in the vicinity of Portuguese solid waste incinerators— Part 1: Biomonitoring of Pb, Cd and Hg in blood of the general population. Int J Hyg Environ Health. 2007;210(3):439–446.
79. Chung JY, Seo MS, Shim JY, Lee YJ. Sex differences in the relationship between blood mercury concentration and metabolic syndrome risk. J Endocrinol Invest. 2015;38(1):65-71.
80. Gundacker C, Komarnicki G, Zödl B, Forster C, Schuster E, Wittmann K. Whole blood mercury and selenium concentrations in a selected Austrian population: Does gender matter? Science of the Total Environment. 2006;372(1):76-86.
81. Björnberg KA, Vahter M, Petersson-Grawe K, Glynn A, Cnattingius S, Darnerud PO, Atuma S, Aune M, Becker W, Berglund M. Methyl mercury and inorganic mercury in Swedish pregnant women and in cord blood: influence of fish consumption. Environ Health Perspect. 2003;111(4):637–641.
How to Cite
Soric, T., Dragičević, I., & Čoklo, M. (2017, March 30). Fish intake, mercury, and metabolic syndrome: a review of the literature. BioMedicine and Surgery, 1(1), 24-31.