Microplastics (MPs) are widely distributed in the ocean and can be ingested by fish. Despite fish being a major source of aquatic protein for humans, no study has yet addressed how to reduce the risk of human exposure to MPs when consuming fish. This study investigated 1,075 fish from 37 species across representative fishing areas, and the presence of MPs in various tissues, such as the gills, guts, and muscles, was analyzed to assess fish food safety comprehensively. MPs (particles >20 μm in size) were detected in 36.28% of the gills and 39.63% of the guts but were not detected in muscle tissues. Compared with those from deeper waters, the fish from upper layers presented greater MP abundances and smaller average sizes. A significant negative correlation was detected between the abundance of MPs in fish and their length and weight. The global per capita MP consumption from captured fish, including all tissues and muscles, is approximately 5.60 × 104 items/year. To minimize dietary exposure to MPs, humans should prioritize consuming only fish muscle and selecting fish from deeper waters and larger sizes whenever possible. Future efforts to optimize fish consumption patterns should involve systematically evaluating the combined risks of MPs and other pollutants, considering both the nutritional value and health benefits of fish consumption and adopting sustainable fishery management approaches.