Concentration of Aflatoxin M 1 and selected heavy metals in mother milk samples from Pakistan

Health risk assessments of heavy metals and trace elements exposure in the breast milk of lactating mothers in the Northeastern Iran

Mother's breast milk is a natural and complete food for infants but can be a main source of exposure to toxic pollutants. These pollutants can negatively affect the health of the infant. Therefore, conducting biomonitoring surveys is essential to evaluate such health effects in toxicological research. This study aimed to estimate the probable health risks for infants exposed to essential and non-essential trace elements through breast milk ingestion. This descriptive-analytical, cross-sectional study was performed on 90 breastfeeding mothers referred to the health centers in Mashhad, Iran in January 2021. The health risk assessments (carcinogenic and non-carcinogenic risk) were estimated using chronic daily intake (CDI), hazard quotient (HQ), hazard index (HI), and lifetime carcinogenic risk (CR), which were recommended by the US Environmental Protection Agency (US EPA). The results of the HQ values of trace elements through ingestion exposure for arsenic (90%), copper (90%), zinc (40%), and iron (10%) exceeded the threshold of HQ, and arsenic (66.59%), copper (16.91%), and zinc (9.68%) and iron (4.57%) had the highest contribution to increasing the HI index. The average value of CR was 5. 08 × 10-3. Chromium and iron showed significant relationships (P<0.05) with education level and disease background in this study, and the concentration of chromium, iron, and zinc in the breast milk samples significantly changed during lactation stages (P<0.05). Overall, the risk of carcinogenicity through exposure to breast milk for infants was higher than the safety level of US EPA risk. Therefore, there could be a potential health risk of trace elements, particularly arsenic, copper, and zinc for infants in Mashhad, Iran through the consumption of mothers' breast milk. More efforts are required to control and reduce routes of receiving trace elements in breastfeeding mothers by the competent authorities.

Assessment of Aflatoxin M1 in human breast and powdered milk in Tehran, Iran

AIM AND BACKGROUND

Aflatoxins, produced by Aspergillus flavus and Aspergillus parasiticus, are among the most toxic mycotoxins. Aflatoxin M1 (AFM1) is a hydroxylated metabolite of aflatoxin B1 (AFB1), found in milk and dairy products from animals fed AFB1-contaminated feed. Consumption of AFM1 has related adverse effects on human health. Breast milk can be a source of contamination for infants due to the presence of AFM. AFM1 can also contaminate powdered milk, a significant product of the milk industry. Consequently, monitoring dairy products for these toxins is imperative.

STUDY METHOD

A total of 50 samples (25 samples of breast milk and 25 samples of powdered infant milk formula) were collected in Tehran from December 2021 to February 2022. HPLC method was used for the determination of AFM1 in samples.

RESULTS

and Discussion: AFM1 was detected in 72% of breast milk samples and 96% of powdered milk samples. AFM1 levels varied significantly between the two sample types (p < 0.05). The average amount of AFM1 in breast milk samples was 25.82 ± 4.72 ng/kg, while the average amount in powdered milk samples was 40.59 ± 7.76 ng/kg. Moreover, 44% of the breast and 68% of powdered milk samples exceeded the AFM1 content limit of the European Union and the Iranian national standard. This study concludes that given the importance of breast milk and formula to maternal and infant health, monitoring and regulating the toxin levels in these products in Tehran is crucial.

Prevalence and concentration of aflatoxin M1 and ochratoxin A in cheese: a global systematic review and meta-analysis and probabilistic risk assessment

Exposure to mycotoxins such as aflatoxins can endanger human health, especially infants and children. In this study, an attempt was made to retrieved studies related to the concentration of aflatoxin M1 (AFM1) and ochratoxin A (OTA). Search was performed in international databases such as Embase, PubMed, Scopus, and Web of Science for the period 1 January 2010 to 20 February 2023. Then, the pooled concentration in the defined subgroups was calculated using meta-analysis and the health risk assessment was conducted by margin of exposure (MOEs). Thirty-one scientific papers with 34 data reports (Sample size=2,277) were included in our study. The lowest and highest prevalence of AFM1 in cheese was related to El Salvador (12.18 %) and Serbia (100.00 %). The pooled prevalence of AFM1 was 49.85 %, 95 %CI (37.93-61.78 %). The lowest and highest prevalence of OTA in cheese was related to Türkiye (6.67 %) and Italy (44.21 %). The pooled prevalence of OTA was 35.64 %, 95 %CI (17.16-56.44 %). Health risk of AFM1 revealed that except Pakistan and Iran, MOE in the other countries was lower than 10,000 for adults and also except Pakistan, MOE for other countries was lower than 10,000 for children. Health risk of OTA revealed that except Greece, MOE in the other countries was higher than 10,000 for adults and also except Germany and Greece, MOE for other countries was higher than 10,000 for children. Therefore, it is recommended to conduct control plans to reduce the concentration of mycotoxins in cheese, especially AFM1.

Human health risk assessment of potentially toxic elements in the breast milk consumed by infants in Western Iran

This study aimed to assess the human health risk of some toxic metals/metalloids [lead (Pb), mercury (Hg), cadmium (Cd), nickel (Ni), chromium (Cr), and arsenic (As)] on infants via consumption of the breast milk of women living in urban areas of Kermanshah city, west of Iran. After collecting milk samples, the carcinogenic and non-carcinogenic risk assessment as well as uncertainty analysis of toxic metal levels were carried out. The order of concentration of heavy metals/metalloids in the breast milk samples was Cr (41.07 ± 23.19) > Ni (19.25 ± 11.81) > Pb (11.5 ± 4.48) > As (1.96 ± 2.04) > Cd (.72 ± 0.42) > Hg (0.31 ± 0.26). The results revealed that the levels of Cr and Pb in the breast milk samples were exceeded the World Health Organization (WHO) tolerable daily intake. In the breast milk samples a high levels of one of the trace elements As, Cd, Cr, Pb, and Ni were observed (over 73%) and in 40% of them the levels of Cr, Pb, Cd, As, and Ni were all above WHO tolerable daily intake. Moreover, the As-related point assessment of target risk factor (THQ) was higher than the allowable limit only for 1-month-old male neonates and 2-month-old female neonates (THQ > 1). In addition, Cr-related THQ scores were higher at all age and gender groups (THQ > 1). In conclusion, our findings suggest a potential risk of some metals for infants via the consumption of mothers' breast milk.

Comprehensive Review of Aflatoxin Contamination, Impact on Health and Food Security, and Management Strategies in Pakistan

Aflatoxins (AFs) are the most important toxic, mutagenic, and carcinogenic fungal toxins that routinely contaminate food and feed. While more than 20 AFs have been identified to date, aflatoxin B1 (AFB1), B2 (AFB2), G1 (AFG1), G2 (AFG2), and M1 (AFM1) are the most common. Over 25 species of Aspergillus have been shown to produce AFs, with Aspergillus flavus, Aspergillus parasiticus, and Aspergillus nomius being the most important and well-known AF-producing fungi. These ubiquitous molds can propagate on agricultural commodities to produce AFs in fields and during harvesting, processing, transportation, and storage. Countries with warmer climates and that produce foods susceptible to AF contamination shoulder a substantial portion of the global AF burden. Pakistan's warm climate promotes the growth of toxigenic fungi, resulting in frequent AF contamination of human foods and animal feeds. The potential for contamination in Pakistan is exacerbated by improper storage conditions and a lack of regulatory limits and enforcement mechanisms. High levels of AFs in common commodities produced in Pakistan are a major food safety problem, posing serious health risks to the population. Furthermore, aflatoxin contamination contributes to economic losses by limiting exports of these commodities. In this review, recent information regarding the fungal producers of AFs, prevalence of AF contamination of foods and feed, current regulations, and AF prevention and removal strategies are summarized, with a major focus on Pakistan.

The concentration and health risk of potentially toxic elements (PTEs) in the breast milk of mothers: a systematic review and meta-analysis

AIM

Breast milk is the best source of nutrition for a newborn during the first six months of his or her life. However there is a possibility that breast milk may contain pollutants such as metals. The current meta-analytic study assessed the concentration of potentially toxic elements (PTEs), including lead (Pb), cadmium (Cd), arsenic (As), Iron (Fe), Zinc (Zn), copper (Cu), and nickel (Ni), in mothers' milk.

METHOD

The literature studies regarding the concentrations of PTEs in the breast milk of mothers were collected from international databases such as PubMed, Scopus, Web of Science, and Embase. Afterward, the Total Target Hazard Quotient (TTHQ) by Monte Carlo Simulation (MCS) model was used to assess the non-carcinogenic risk.

RESULTS AND DISCUSSION

According to 42 of the 836 retrieved articles, the PTE concentrations in mother's milk were as follows: Cu (1.84 mg/kg) > Zn (1.80 mg/kg) > Fe (1.03 mg/kg) > Ni (0.60 mg/kg) > Pb (0.10 mg/kg) > As (0.15 mg/kg) ≈ Cd (0.15 mg/kg). Based on the containment type, the highest concentrations of As (2.80 mg/kg), Cd (0.07 mg/kg), and Pb (2.68 mg/kg) were related to Western Pacific Region (WPRO), European Region (EURO), and WPRO, respectively. In addition, for trace elements, Eastern Mediterranean Region (EMRO) was the region with the highest concentrations of Cu (3.56 mg/kg), Fe (2.78 mg/kg), Ni (3.13 mg/kg), and Zn (5.58 mg/kg) were related to Lastly, the non-carcinogenic risk assessment of the PTEs in breast milk indicated different risk patterns in various countries, and the calculated TTHQ level in infants was below 1.

CONCLUSION

Overall, human breast milk was generally safe for infants to consume and poses no risks to their health.

Contamination, exposure, and health risk assessment of Hg in Pakistan: A review

Mercury is a highly toxic and highly mobile heavy metal. It has been regarded as more toxic than other nonessential and toxic nonradioactive heavy metals. Moreover, it has a high tendency of bioaccumulation and biomagnification in the ecosystem. This study aimed to assess the environmental and health risks related to Hg. Seventy studies related to Hg in environmental media, aquatic biota, and food stuffs across Pakistan were reviewed, and their concentrations were used for ecological and human health risk assessments. High concentrations of Hg were reported in the environment, with maximum concentrations of 72 mg L^-1, 144 mg kg^-1, 887 mg kg^-1, and 49,807 ng m^-3 in surface water, surface soil, surface sediments, and urban atmosphere, respectively. The possible non-carcinogenic health risk (hazard quotient) of Hg was assessed in soil, water, and fish. High risks were calculated for seafood and vegetable consumption, while low risks were estimated for soils and groundwater ingestion and exposure. Overall, children showed higher risks than adults. Last, the risk quotient analysis (RQ) revealed significant risks for aquatic species. RQs showed that multiple species, especially those with smaller resilience, could face long-term detrimental impacts. High, medium, and low risks were calculated from 66.66, 16.17, and 16.17% of the reported Hg concentrations.

Risk of dietary and breastmilk exposure to mycotoxins among lactating women and infants 2-4 months in northern India

Mycotoxins are carcinogenic secondary metabolites of fungi that have been linked to infant growth faltering. In this study, we quantified co-occurring mycotoxins in breast milk and food samples from Haryana, India, and characterized determinants of exposure. Deterministic risk assessment was conducted for mothers and infants. We examined levels of eight mycotoxins (Aflatoxin B1 , B2 , G1 , G2 , M1 , M2 ; Ochratoxin A, B) in 100 breast milk samples (infants 2-4 months) using ultra-high-performance liquid chromatography tandem mass spectrometry. Aflatoxin B1 (AFB1 ), fumonisin B1 (FB1 ) and deoxynivalenol (DON) were detected in several food items (n = 298) using enzyme-linked immunosorbent assays. We report novel data on the presence of mycotoxins in breast milk samples from India. Whereas breast milk concentrations (AFM1 median: 13.7; range: 3.9-1200 ng/L) remain low, AFM1 was detected above regulatory limits in 27% of animal milk samples. Additionally, 41% of infants were above provisional maximum tolerable daily intake (PMTDI) limits for AFM1 due to consumption of breast milk (mean: 3.04, range: 0.26-80.7 ng kg-1 bw day-1 ). Maternal consumption of breads (p < 0.05) was associated with breast milk AFM1 exposure. AFB1 (μg/kg) was detected in dried red chilies (15.7; 0-302.3), flour (3.13; 0-214.9), groundnuts (0; 0-249.1), maize (56.0; 0-836.7), pearl millet (1.85; 0-160.2), rice (0; 0-195.6), wheat (1.9; 0-196.0) and sorghum (0; 0-63.5). FB1 (mg/kg) was detected in maize (0; 0-61.4), pearl millet (0; 0-35.4) and sorghum (0.95; 0-33.2). DON was not detected in food samples. Mothers in our study exceeded PMTDI recommendations for AFB1 due to consumption of rice and flour (mean: 75.81; range: 35.2-318.2 ng kg-1 bw day-1 ). Our findings show the presence of Aflatoxin B1 and M1 at various levels of the food chain and in breast milk, with estimated intakes exceeding PMTDI recommendations. Aflatoxins are known carcinogens and have also been linked to stunting in children. Their presence across the food system and in breast milk is concerning, thus warranting further research to replicate and expand on our findings and to understand implications for maternal and child health.

Evaluation and Assessment of Aflatoxin M1 in Milk and Milk Products in Yemen Using High-Performance Liquid Chromatography

Aflatoxin M1 is one of the major fungal contaminants found in dairy products around the globe. The objective of this study was to investigate the incidence and occurrence of aflatoxin M1 (AFM1) in samples of milk and milk products in Yemen. The tested dairy product samples were collected from different sources for aflatoxin M1 (AFM1) in Yemen. A total of 250 local and imported samples consisting of 38 liquid milk, 60 powder milk, 62 yogurt, and 90 cheese samples which are marketed throughout Yemen were tested by using high-performance liquid chromatography (HPLC) along with a fluorescence detector and immunoaffinity column purification for detection of AFM1. High levels of AFM1 were detected in preserved milk (77.24%), ranging from 0.021 μg/L to 5.95 μg/L. On the other hand, AFM1 was detected in 66.66% and 68.42% in powdered milk and liquid milk samples, respectively. Among dairy products, 87.09% of yogurt and 81.39% of cheese samples were found contaminated with AFM1. The AMF1 values were higher than the acceptable range for humans set by the European Union. So, we concluded that dairy products used in Yemen showed an AFM1 content beyond the acceptable range, and this is a major factor for causing health-related complications including cancer. In the present study, we reported for the first time the presence of mycotoxins especially AFM1 in dairy products used in Yemen.

Prevalence and Exposure Assessment of Aflatoxins Through Black Tea Consumption in the Multan City of Pakistan and the Impact of Tea Making Process on Aflatoxins

Aflatoxins are the highly toxic secondary metabolites of certain fungi, being mainly produced by Aspergillus flavus and Aspergillus parasiticus. Aflatoxins are classified as group 1 category carcinogens by the International Agency for Research on Cancer (IARC). A large number of food commodities are reported to be contaminated with aflatoxins. Tea is the world's second most consumed beverage and the consumption of tea is increasing day by day. Besides being a source of several health promoting substances, tea leaves are also reported to be contaminated with aflatoxins. However, not a single study is reported from Pakistan regarding the level of aflatoxins in commercially available black tea samples. The current study aimed to quantify the level of aflatoxins in commercially available branded and non-branded black tea samples. The estimated daily intake (EDI) of aflatoxins through branded and non-branded black tea consumption and the health risk assessment based on margin of exposure (MOE) approach was assessed. Furthermore, the impact of local tea making processes on the concentration of aflatoxins in tea beverage (filtrate) was also investigated.