Occurrence and dietary factors associated with the presence of aflatoxin B1 and M1 in breast milk of nursing mothers in Iran

Determination of aflatoxin M1 and ochratoxin A in breast milk in rural centers of Yazd, Iran: Exposure assessment and risk characterization

Breast milk (BM) is considered as the best source of nutrition which could have prevention effects on various diseases in the first years of a child. Along with nutritive compounds, presence of contaminants such as mycotoxins in BM could be transmitted into neonate. The aim of this study was to determine the occurrence, levels, and factors associated with the presence of aflatoxin M1 (AFM1) and ocratoxin a (OTA) in BM samples of nursing mothers in rural centers of Yazd, Iran. The presence and average AFM1 and OTA concentration in 72 BM samples was measured by competitive ELISA. The demographic and diet parameters of nursing mothers were collected by a questionnaire and were analyzed using SPSS 18 software. AFM1 and OTA were detected in 63 (87.5%) and 47 (65.2%) samples with the mean concentration levels of 19.46 ± 13.26 ng/L (ranges from 5.1 to 53.9) and 200 ± 160 ng/L (ranges from 100 to 2460), respectively. Of these, 32 samples (50.7%) for AFM1 and 23 samples (48.9%) for OTA had values exceeding the limit set by the European Union regulation for infant foods (25 ng/L for AFM1 and 500 ng/L for OTA). It was also found that the risk of AFM1 and OTA occurrence in BM increased significantly with the consumption of beans, bread, cereals, fruit juice and crackers, and cream, respectively. This study showed that the estimated daily intake for AFM1 and OTA by 1 month of age infants was 2.7 and 28.5 ng/kg bw/day, respectively, while, as the age of the infant increased, the values were lower and close to 0.9 and 9.9 ng/kg bw/day for AFM1 and OTA in 12 months of age infants, respectively. The high occurrence and noticeable levels of AFM1 and OTA detected in this study indicated that some infants receive undesirable exposures to AFM1 and OTA with breast milk. Therefore, it is recommended that mothers are advised to avoid certain foods during pregnancy and breastfeeding that are likely sources of mycotoxins.

Dietary aflatoxin exposure of lactating mothers of children 0-6 months in Makueni County, Kenya

The southeastern region of Kenya is prone to aflatoxin outbreaks, yet maternal and infant aflatoxin intake levels remain unclear. We determined dietary aflatoxin exposure of 170 lactating mothers breastfeeding children aged 6 months and below in a descriptive cross-sectional study involving aflatoxin analysis of maize-based cooked food samples (n = 48). Their socioeconomic characteristics, food consumption patterns and postharvest handling of maize were determined. Aflatoxins were determined using high-performance liquid chromatography and enzyme-linked immunosorbent assay. Statistical analysis was conducted using Statistical Package Software for Social Sciences (SPSS version 27) and Palisade's @Risk software. About 46% of the mothers were from low-income households, and 48.2% had not attained the basic level of education. A generally low dietary diversity was reported among 54.1% of lactating mothers. Food consumption pattern was skewed towards starchy staples. Approximately 50% never treated their maize, and at least 20% stored their maize in containers that promote aflatoxin contamination. Aflatoxin was detected in 85.4% of food samples. The mean of total aflatoxin was 97.8 μg/kg (standard deviation [SD], 57.7), while aflatoxin B1 was 9.0 μg/kg (SD, 7.7). The mean dietary intake of total aflatoxin and aflatoxin B1 was 7.6 μg/kg/b.w.t/day (SD, 7.5) and 0.6 (SD, 0.6), respectively. Dietary aflatoxin exposure of lactating mothers was high (margin of exposure < 10,000). Sociodemographic characteristics, food consumption patterns and postharvest handling of maize variably influenced dietary aflatoxin exposure of the mothers. The high prevalence and presence of aflatoxin in foods of lactating mothers are a public health concern and calls for the need to devise easy-to-use household food safety and monitoring measures in the study area.

Mycotoxins Exposure in Cabinda, Angola—A Pilot Biomonitoring Survey of Breastmilk

Breast milk is considered the ideal form of nutrition for newborns and infants. However, it can carry over contaminants, namely mycotoxins, with biological effects to which this population is particularly vulnerable. Human biomonitoring and surveillance programs are particularly scarce in low-income countries, where food security is a more urgent priority in comparison with food safety. This pilot survey aims to assess exposure of breastfed infants to aflatoxin M1 (AFM1), zearalenone (ZEN), and ochratoxin A (OTA) in Angola, and to evaluate the main socio-demographical and food consumption determinants of lactating mothers. All 37 breast milk samples analyzed are found to be contaminated with ZEN and OTA, although none are found contaminated with AFM1. Contamination levels are lower than previously reported for ZEN but higher in the case of OTA. A significant association between ZEN levels in breast milk and the consumption of cookies by the lactating mothers is found. As for OTA, higher levels are observed in the milk from mothers with younger infants, for which high estimated daily intake (EDI) is determined. As far as the authors are aware, this is the first survey of the occurrence of mycotoxins in breast milk in Angola, so further human biomonitoring works should follow, given that mycotoxins are a global health issue that directly impact the health of populations.

Levels of Aflatoxin M1 in Breast Milk of Lactating Mothers in Monterrey, Mexico: Exposure and Health Risk Assessment of Newborns

The present study aimed to determine the presence of the aflatoxin M1 (AFM1) in breast milk samples from 123 nursing women and the degree of exposure of infants to this toxin, in the metropolitan area of Monterrey, Nuevo Leon state (northeast Mexico). Upon analysis, 100% of the samples were found to be contaminated with the toxin at an average concentration of 17.04 ng/L, with a range of 5.00 to 66.23 ng/L. A total of 13.01% of the breast milk samples exceeded the regulatory limit of 25 ng/L for AFM1 concentration, set by the European Union. The estimated daily intake for AFM1 and the carcinogenic risk index were also determined in the 0- to 6-, 7- to 12-, 13- to 24-, and 25- to 36-month-old age groups. The AFM1 intake through breast milk ranged from 1.09 to 20.17 ng/kg weight/day, and was higher than the tolerable daily intake, indicating a carcinogenic risk for infants in the age groups of 0- to 24-months old. This evidence demonstrates a susceptibility of breast milk to AFM1 contamination that may suggest a carcinogenic risk for the breastfed infants in Monterrey city, Nuevo Leon state, and the need to control the presence of aflatoxins in foods eaten by nursing mothers.

Evaluation of Mycotoxins in Infant Breast Milk and Infant Food, Reviewing the Literature Data

In this review, an analysis focusing on mycotoxin determination in infant breast milk and infant food has been summarised for the last fifteen years of research focused on the intended population group of 1-9 months. The objective was to know the level of exposure of the child population to an estimated daily intake (EDI) of mycotoxins from the consumption of habitual foods. The EDI was compared with the tolerable daily intake (TDI) established by EFSA to estimate risk. In breast milk, the high prevalence and levels were for samples from Africa (Egypt and Tanzania) with aflatoxin M1 (1.9 μg/L and 10%), and Asia (Iran) with ochratoxin-A (7.3 μg/L and 100%). In infant formulas, high incidences and values were for samples with aflatoxin M1 from Burkina Faso (167 samples, 84%, 87 μg/kg). In cereal products, the highest incidence was for DON from the United States (96 samples), and the highest value was an Italian sample (0.83 μg/kg of enniatin B). In fruit products, patulin was the most detected in Italian (78) and Spanish (24) samples. The highest risk was observed in breast milk during the first month of age, the highest EDI for aflatoxin M1 was reported for Egypt (344-595 ng/kg bw/day) and ochratoxin-A for Iran (97-167ng/kg bw/day), representing a public health problem.

Mycotoxin occurrence in breast milk and exposure estimation of lactating mothers using urinary biomarkers in São Paulo, Brazil

In this study, the occurrence of aflatoxins (AFs), fumonisins (FBs), ochratoxin A (OTA), deoxynivalenol (DON), zearalenone (ZEN) and some of their metabolites were assessed in breast milk and urine of lactating women (N = 74) from Pirassununga, São Paulo, Brazil. Exposure estimations through urinary mycotoxin biomarkers was also performed. Samples were collected in four sampling times (May and August 2018, February and July 2019) and analyzed by liquid chromatography coupled to tandem mass spectrometry. Aflatoxin M₁ (AFM₁) was not detected in breast milk. However, two samples (3%) presented FB₁ at 2200 and 3400 ng/L, while 4 samples (5%) had OTA at the median level of 360 ng/L. In urine, AFM₁ and aflatoxin P₁ (AFP₁) were found in 51 and 11% of samples, respectively (median levels: 0.16 and 0.07 ng/mg creatinine, respectively). Urinary DON (median level: 38.59 ng/mg creatinine), OTA (median level: 2.38 ng/mg creatinine) and ZEN (median level: 0.02 ng/mg of creatinine) were quantified in 18, 8 and 10% of the samples, respectively. Mean probable daily intake (PDI) values based on urinary biomarkers were 1.58, 1.09, 5.07, and 0.05 μg/kg body weight/day for AFM₁, DON, OTA, and ZEN, respectively. Although a low mycotoxin occurrence was detected in breast milk, the PDI for the genotoxic AFs was much higher than those reported previously in Brazil, while PDI values obtained for OTA and DON were higher than recommended tolerable daily intakes. These outcomes warrant concern on the exposure of lactating women to these mycotoxins in the studied area.

An assessment of the occurrence and nutritional factors associated with aflatoxin M1, ochratoxin A, and zearalenone in the breast milk of nursing mothers in Hamadan, Iran

This research investigated the occurrence of aflatoxin M1 (AFM1), ochratoxin A (OTA), and zearalenone (ZEN) in human milk samples in the Hamadan city, Iran. The study was carried out using the milk of nursing mothers from ten governmental health care centers. Mycotoxin content of ninety milk samples measured using enzyme-linked immunosorbent assay (ELISA). All samples that tested positive for AFM1 with the ELISA test were subsequently analyzed by high-performance liquid chromatography (HPLC). The mean ± SD concentrations of AFM1, determined by ELISA and HPLC were 5.98 ± 1.47 and 4.36 ± 1.23 ng/L, respectively. OTA and ZEN levels were below the detection limit (<5 ng/L) in all samples. None of the contaminated samples exceeded the regulation limit set by the European Commission (25 ng/L) for AFM1 in infant formula. We found a significant correlation between the AFM1 concentration in breast milk and infant age and milk consumption by the nursing mother (p < 0.05). These findings revealed that infants are susceptible to AFM1 exposure from their mother's milk. The authors recommend that additional research be conducted on the analysis of foodstuff and biological fluids for various mycotoxins.

Occurrence of and Factors Associated With the Presence of Aflatoxin M1 in Breast Milk of Mothers in Fethiye, Turkey

Aflatoxins comprise a group of mycotoxins that are found in the environment. Exposure to aflatoxins has been reported to cause serious health problems in humans. Since aflatoxin M₁ (AFM₁) is secreted in breast milk, the exposure of infants to this toxin is an important concern. The aim of this study was to determine the prevalence, levels of, and factors associated with the presence of AFM₁ in breast milk of mothers in Fethiye, Turkey. Breast milk samples were taken from 100 mothers who had given birth over the period of October-November 2017. The AFM₁ content of the samples was determined via enzyme-linked immunosorbent assay. The lowest limit for milk samples in the Ridascreen® AFM₁ commercial test kit is 5 ng/L. Because of this, AFM₁ levels below 5 ng/L in the breast milk samples were assessed as negative. Of the breast milk samples tested, 53 were positive. The average AFM₁ amount in the positive samples was 6.36 ng/L (ppt; range 5.10-8.31 ng/L). Mothers who were housewives, lived in damp, humid houses, or ate spices or dried fruits and vegetables had significantly greater prevalence of AFM₁ in their breast milk than those who were employed, did not report dampness or mold in the home, or did not eat spices or dried fruits and vegetables. AFM₁ in breast milk could be an important risk factor for infant health. Informing the public about food safety could reduce the amount of AFM₁ being transferred into breast milk via food channels.

Mycotoxin toxicity and residue in animal products: Prevalence, consumer exposure and reduction strategies - A review

Mycotoxin residues are transferred from feed to animal products, yet, less attention has been paid to it in developing countries. There is a need to find alternative alleviation material for reducing the impact of mycotoxin. This review is meant to elucidate different additives that can reduce mycotoxin residue in animal products in the world, especially in developing countries. There is evidence of relationship between mycotoxin residue in breast milk of nursing mothers and mycotoxin exposure through crop and animal product (egg and milk) intake, especially in Asia, Africa, Middle East, Latin America, and some parts of Europe. Younger livestock tends to have more toxin residues in their tissue compared to older ones. Grazing animal are also exposed to mycotoxin intake which corresponds to high level of mycotoxins in their products including meat and milk. This review shows that phytogenic, probiotic, and prebiotic additives can decrease mycotoxin residues in milk, eggs, meat liver and other tissues of livestock. Specifically, bentonites, difructose anhydride III, yeast (Trichosporon mycotoxinivorans), Bacillus spp., or their biodegradable products can reduce mycotoxin residue in animal products. In addition, Ally isothiocyanates from mustard seed were able to mitigate mycotoxins in silo-simulated system. Evidence shows that there are now low-cost, accessible, and eco-friendly additives, which could alleviate the effect of mycotoxin in feed and food. In addition, there is need for aggressive public awareness and farmers' education on the prevalence, and danger caused by mycotoxins, as well as detoxification strategies that can reduce toxin absorption into animal products.

Concentration and Prevalence of Aflatoxin M1 in Human Breast Milk in Iran: Systematic Review, Meta-Analysis, and Carcinogenic Risk Assessment: A Review

This meta-analysis was designed to review the published reports regarding the concentration and/or prevalence of aflatoxin M₁ (AFM₁) in human breast milk in Iran. The carcinogenic risk for Iranian infants consuming this milk was estimated with the hazard index. The PubMed and Scopus databases and the Scientific Information Database were screened for relevant studies between 1995 and 2017, and 11 of the 112 collected studies were included in the systematic review and meta-analysis. The mean (95% confidence interval) concentration of AFM₁ was 5.85 ng/L (4.54 to 7.15 ng/L), which was lower than the European Union standard (25 ng/L). The mean prevalence of AFM₁ in breast milk in Iran was 42% (11 to 77%). The estimated daily intakes for male and female infants were 0.02 to 5.57 ng/kg and 0.02 to 3.68 ng/kg of body weight per day, respectively. The rank order of estimated daily intake for both male and female infants according to age was 1 week > 1 month > 6 months > 12 months. The hazard index for all age groups of infants in all provinces in Iran was less than 1. Therefore, infants in Iran were not considered at carcinogenic risk from AFM₁ in human breast milk.