Aflatoxin contamination in unrecorded beers from Kenya – A health risk beyond ethanol

Review of the Terminology, Approaches, and Formulations Used in the Guidelines on Quantitative Risk Assessment of Chemical Hazards in Food

This paper reviews the published terminology, mathematical models, and the possible approaches used to characterise the risk of foodborne chemical hazards, particularly pesticides, metals, mycotoxins, acrylamide, and polycyclic aromatic hydrocarbons (PAHs). The results confirmed the wide variability of the nomenclature used, e.g., 28 different ways of referencing exposure, 13 of cancer risk, or 9 of slope factor. On the other hand, a total of 16 equations were identified to formulate all the risk characterisation parameters of interest. Therefore, the present study proposes a terminology and formulation for some risk characterisation parameters based on the guidelines of international organisations and the literature review. The mathematical model used for non-genotoxic hazards is a ratio in all cases. However, the authors used the probability of cancer or different ratios, such as the margin of exposure (MOE) for genotoxic hazards. For each effect studied per hazard, the non-genotoxic effect was mostly studied in pesticides (79.73%), the genotoxic effect was mostly studied in PAHs (71.15%), and both effects were mainly studied in metals (59.4%). The authors of the works reviewed generally opted for a deterministic approach, although most of those who assessed the risk for mycotoxins or the ratio and risk for acrylamide used the probabilistic approach.

Defining No and Low (NoLo) Alcohol Products

Reducing the alcoholic strength in beverages as a strategy to reduce harmful alcohol use has been proposed by multilateral institutions such as the World Health Organization and governments worldwide. Different industrial and artisanal techniques are used to achieve low-alcohol content beverages. Therefore, regulations regarding the content of alcohol in beverages and strategies to monitor compliance are important, because they are the main reason for classification of the beverages and are central to their categorization and market labelling. Furthermore, analytical techniques with adequate sensitivity as low as 0.04% vol are necessary to determine the alcohol ranges necessary for classification. In this narrative review, the definitions of no and low (NoLo) alcohol products are described and the differences in the legal definitions of these products in several regions of the world are highlighted. Currently, there is clearly confusion regarding the terminology of "no", "free", "zero", "low", "light", or "reduced" alcohol products. There is an urgent need for global harmonization (e.g., at the Codex Alimentarius level) of the definitions from a commercial perspective and also to have common nomenclature for science and for consumer information.

Margin of Exposure Analyses and Overall Toxic Effects of Alcohol with Special Consideration of Carcinogenicity

Quantitative assessments of the health risk of the constituents of alcoholic beverages including ethanol are reported in the literature, generally with hepatotoxic effects considered as the endpoint. Risk assessment studies on minor compounds such as mycotoxins, metals, and other contaminants are also available on carcinogenicity as the endpoint. This review seeks to highlight population cancer risks due to alcohol consumption using the margin of exposure methodology. The individual and cumulative health risk contribution of each component in alcoholic beverages is highlighted. Overall, the results obtained consistently show that the ethanol contributes the bulk of harmful effects of alcoholic beverages, while all other compounds only contribute in a minor fashion (less than 1% compared to ethanol). Our data provide compelling evidence that policy should be focused on reducing total alcohol intake (recorded and unrecorded), while measures on other compounds should be only secondary to this goal.

A worldwide systematic review, meta-analysis, and health risk assessment study of mycotoxins in beers

Mycotoxins, including aflatoxins (AFs), ochratoxin A (OTA), deoxynivalenol (DON), fumonisins (FBs), and zearalenone (ZEN), have been reported as beer contaminants. This systematic review and meta-analysis provide the prevalence and concentration of mycotoxins in beers and their worldwide distribution. Mycotoxin's exposure and cancer risk through beer consumption were determined. The overall pooled prevalence of mycotoxins in beers was 31% (95% confidence interval [CI] = 28%-35%; I²  = 90%, p = .00). The most prevalent mycotoxins in beers were DON and its derivatives (53%), OTA (52%), FBs (47%), followed by AFs (12%). Iran (99%), Hungary (95%), Denmark (92%), Armenia (83%), and Cyprus (83%) had the highest mycotoxin prevalence in beers. The global mycotoxins average concentration in beers was 12.52 μg/L (95% CI = 10.70-14.75 μg/L; I²  = 100%, p = .00). DON and its derivatives showed the highest concentration (26.91 μg/L), followed by FBs (23.19 μg/L), ZEN and its derivatives (20.25 μg/L), and AFs (15.65 μg/L). African region had the highest mycotoxins concentration (73.95 μg/L) mostly due to the high levels reported in beers from Cameroon (293.02 μg/L), Malawi (132.34 μg/L), and Eastern Cape province (126.12 μg/L). The meta-regression indicated stability (p ≥ .05) of the global pooled concentration of mycotoxins in beers over the years, whereas FBs concentration increased. The intake of DON and its derivatives, FBs, ZEN and its derivatives, and OTA through beers is of concern in African countries. OTA is also of concern in Brazil and Belgium. Results show high mycotoxins concentration in beers worldwide and highlight the health risks through contaminated beer consumption.

Physicochemical Changes Occurring during Long-Time Fermentation of the Indigenous Alcoholic Sorghum-Based Beverages Brewed in Northern Cameroon

In Cameroon, alcoholic beverages represent one of the main consumed drinks. In northern regions, indigenous sorghum beers are very popular and widely consumed in an actively fermenting state by people. In this study, some physicochemical parameters of alcoholic sorghum beverages and correlations between them were evaluated during fermentation for 10 days. The indigenous white and red beers were produced at the laboratory scale assisted by experimental producers and some parameters (pH, total acidity, alcohol, sugars, density, total solids, temperature, and conductivity) were measured on the wort and fermented beverages. The pH decreased from 3.2 to 2.4 and 3.11 to 2.41; total acidity increased from 1.07 to 5.1 g/L and 0.5 to 4.6 g/L; alcohol was enhanced from 0 to 9.5% and 0 to 6.8% (v/v); total solids dropped from 13.6 to 5°P and 12.2 to 3.3°P, respectively, in the white and red sorghum beers. The multivariate analysis showed a good correlation between consumption of sugar, the decrease in total solids and density with the decrease in pH. Additionally, it was shown that a perfect link exists between the production of alcohol and organic acids. The hierarchical analysis showed that indigenous red beer samples fermented for one and two days and those fermented for four to 10 days were related and could be separate in two distinct groups, whereas white turbid beer samples were separated in three different groups, those fermented for one to four days, five to six days, and seven to 10 days. The results obtained could serve as a guide to better understand the fermentation process of indigenous alcoholic sorghum-based beverages.

Mycotoxins in artisanal beers: An overview of relevant aspects of the raw material, manufacturing steps and regulatory issues involved

The consumption of artisanal beer has increased worldwide. Artisanal beers can include malted or unmalted wheat, maize, rice and sorghum, in addition to the basic ingredients. These grains can be infected by toxigenic fungi in the field or during storage and mycotoxins can be produced if they find favorable conditions. Mycotoxins may not be eliminated throughout the beer brewing and be detected in the final product. In addition, modified mycotoxins may also be formed during beer brewing. This review compiles relevant information about mycotoxins produced by Aspergillus, Fusarium and Penicillium in raw material of artisanal beer, as well as updates information about the production and fate of mycotoxins during the beer brewing process. Findings highlight that malting conditions favor the production of mycotoxins by the fungi contaminating cereals. Therefore, good agricultural and postharvest mitigation strategies are the most effective options for preventing the growth of toxigenic fungi and the production of mycotoxins in cereals. However, the final concentration of mycotoxin in artisanal beer is difficult to predict as it depends on the initial concentration contained in the raw material and the processing conditions. The current lack of limits of mycotoxins in artisanal beer underestimates possible risks to human health. In addition, modified mycotoxins, not detected by conventional methods, may be formed in artisanal beers. Maximum tolerated limits for these contaminants must be urgently established based on scientific data about transfer of mycotoxins throughout the artisanal beer brewery process.

Assessing the Aflatoxins Mitigation Efficacy of Blueberry Pomace Biosorbent in Buffer, Gastrointestinal Fluids and Model Wine

Blueberry (BB) and cherry pomace were investigated as new biosorbents for aflatoxins (AFs) sequestration from buffered solutions, gastrointestinal fluids and model wine. Among the tested biosorbents, BB exhibited the maximum adsorption performance for AFs and hence was further selected for the optimization of experimental parameters like pH, dosage, time and initial concentration of AFs. Material characterizations via scanning electron microscopy (SEM), Fourier transform infrared (FTIR) spectroscopy, N2 adsorption-desorption isothermal studies, thermogravimetric analysis (TGA) and X-ray photon spectroscopy (XPS) techniques revealed useful information about the texture and chemical composition of the biosorbents. The fitting of isothermal data with different models showed the model suitability trend as: Sips model > Langmuir model > Freundlich model, where the theoretical maximum adsorption capacity calculated from the Sips model was 4.6, 2.9, 2.7 and 2.4 mg/g for AFB1, AFB2, AFG1 and AFG2, respectively. Kinetics study revealed the fast AFs uptake by BB (50-90 min) while thermodynamics studies suggested the exothermic nature of the AFs adsorption from both, single as well as multi-toxin buffer systems, gastrointestinal fluids and model wine. Accrediting to the fast and efficient adsorption performance, green and facile fabrication approach and cost-effectiveness, the newly designed BB pomace can be counted as a promising contender for the sequestration of AFs and other organic pollutants.

Changes Occurring in Spontaneous Maize Fermentation: An Overview

Maize and its derived fermented products, as with other cereals, are fundamental for human nutrition in many countries of the world. Mixed cultures, principally constituted by lactic acid bacteria (LAB) and yeasts, are responsible for maize fermentation, thus increasing its nutritional value and extending the products’ shelf-life. Other microorganisms involved, such as molds, acetic acid bacteria, and Bacillus spp. can contribute to the final product characteristics. This review gives an overview of the impact of the activities of this complex microbiota on maize product development and attributes. In particular, starting from amylolytic activity, which is able to increase sugar availability and influence the microbial succession and production of exopolysaccharides, vitamins, and antimicrobial compounds, which improve the nutritional value. Further activities are also considered with positive effects on the safety profile, such as phytates detoxification and mycotoxins reduction.

Bioaccessibility in daily diet and bioavailability in vitro of aflatoxins from maize after cooking

Bioavailability is not a constant percentage of a contaminant in food but is affected by many factors, such as food type, treatment, diet structure and interaction with other compounds. To evaluate these influences, we measured the bioaccessibility of aflatoxins from nine naturally polluted maize samples, collected from southeast China, using an in vitro digestion model, and analysed the intestinal transport of aflatoxins by a Caco-2 cell model. Steam cooking treatment could reduce the aflatoxin levels in maize bread. The degradation rates of aflatoxin B1, aflatoxin B2, aflatoxin G1, and aflatoxin G2 ranged from 24.9±3.2 to 33.9±3.5%, 27.0±2.0 to 39.0±1.8%, 27.9±7.9 to 34.4±8.2% and 25.6±3.6 to 37.2±6.5%, respectively. As a result, the bioaccessibility of aflatoxins determined by an in vitro digestion model (41.5-63.3%) was much lower than the previously reported 80%. Edible oil could increase the bioaccessibility of aflatoxin, whereas lettuce would decrease the exposure amount from maize. With a Caco-2 cell model, the apparent permeability coefficient exceeding 10-5 cm/s indicated that there is high absorption of aflatoxins in the human body, while the intestinal transport can be effectively restrained in the presence of chlorophyll.

Unrecorded alcohol in East Africa: A case study of Kenya

Alcohol misuse contributes substantially to the global morbidity and mortality burden. Unrecorded alcohol, alcohol that is purchased by means which precludes regulation, represents a substantial proportion of the alcohol consumed in East Africa. In Kenya, homebrew also known as traditional brew, has been linked to several fatalities and hospitalizations. Previously banned, the Kenyan government recently legalized homebrew in an effort to regulate and reduce its harm. Despite legalization, however, homebrew continues to be endemic. In this paper, we examine the scope and harm associated with unrecorded alcohol in Kenya, and discuss current policies and interventions aimed at reducing production and consumption of unrecorded alcohol in the Kenyan context that reflect its culture, politics, environment and resources.

Examining characteristics of recorded and unrecorded alcohol consumers in Kenya

BACKGROUND

Due to media reports of several deaths, consumption of unrecorded alcohol (i.e., alcohol brewed at home) has emerged as a public health threat in developing countries like Kenya. Empirical data on this issue, however, is scarce. This investigation compared demographic characteristics of Kenyans who drank recorded (regulated) and unrecorded alcohol.

METHODS

We examined all respondents who consumed alcohol in the past month (N = 718) on the 2015 nationally representative Kenya STEPwise survey. Descriptive statistics and bivariate logistic regression examined proportion of respondents consuming unrecorded alcohol, and social demographic factors associated with unrecorded alcohol consumption, respectively.

RESULTS

The sample was primarily male (86%), married (64%), middle class or higher (64%), with an average age of 37 years. Participants reported an average of 2.5 drinking events and 4.3 binge-drinking occasions per month. Overall, 37% of our sample consumed unrecorded alcohol. Compared to those with incomplete primary education or lower, individuals who completed primary education or above were less likely to report consuming unrecorded alcohol (OR = 0.22, 95% CI: 0.12-0.43). Compared to poorest and poor respondents, those identifying as middle class or above were less likely to consume unrecorded alcohol (OR = 0.47, 95% CI: 0.29-.78). Current smokers (OR = 2.19, 95% CI: 1.34-3.60) and those with higher binge drinking occasions in the past month (OR = 1.03, 95% CI: 1.004-1.07) were significantly more likely to consume unrecorded alcohol.

CONCLUSION

Kenyan adults who consume unrecorded alcohol engage in more binge drinking occasions, smoke, and have lower levels of education and socioeconomic status. It is vital that health promotion interventions aimed at reducing unrecorded alcohol consumption be tailored and targeted to individuals with low socio-economic status in Kenya.