Urinary levels of 19 elements (i.e., As, Ba, Be, Cd, Co, Cs, Cu, Mn, Mo, Ni, Pb, Pt, Sb, Se, Th, Tl, U, V, and Zn) in 518 adults representative of the Valencian Region in Spain were measured in the present study. Essential metals such as Cu, Zn, Mn, and Se showed 100% detection frequency (DF). Toxic metals like As and Pb were detected in 100% of participants, while Cd was found in 75%. Associations between metal levels and dietary or lifestyle factors were notable. Seafood consumption was a key contributor to elevated As, Se, and Cs levels, while smoking strongly influenced Cd, Pb, and Tl. These findings underscore the role of dietary habits in exposure to both essential and toxic metals. Hazard Quotients (HQs) were calculated for Se, Mo, Zn, Ba, Cd, and Tl using volume and creatinine-based normalizations. Essential elements posed no significant risks (HQ < 1), though Zn approached the threshold (HQ = 0.91). However toxic elements such as Cd and Tl showed minimal risk. This study highlights the need for public health strategies to reduce exposure to toxic metals such as Cd and Pb, while continuing to monitor essential metals to prevent overexposure. The results provide a valuable basis for policy making and international comparisons.This work was supported by the Public Health General Directorate of Valencia together with FISABIO, which financed the BIOMOVAL project and by the University of Alicante (UAIND21-03C)
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