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Murashiki TC, Mazhandu AJ, Zinyama-Gutsire RBL, Mutingwende I, Mazengera LR, Duri K. Biomonitoring and determinants of mycotoxin exposures from pregnancy until post-lactation in HIV-infected and HIV-uninfected women from Harare, Zimbabwe. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2024:1-23. [PMID: 39284005 DOI: 10.1080/19440049.2024.2402553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 08/14/2024] [Accepted: 09/02/2024] [Indexed: 10/11/2024]
Abstract
The human immunodeficiency virus (HIV) heavily affects women from resource-limited settings who are vulnerable to potentially harmful mycotoxins including aflatoxin B1 (AFB1), fumonisin B1 (FB1) and ochratoxin A (OTA). We aimed to conduct biomonitoring and ascertain the determinants of maternal mycotoxin exposure in pregnancy, lactation and post-lactation periods. We conducted a retrospective longitudinal study in HIV-infected and HIV-uninfected women from Harare, Zimbabwe. 175 and 125 random urine samples in pregnancy and 24 months after delivery (post-lactation) respectively were analysed for aflatoxin M1 (AFM1) and FB1 by ELISA. 6 weeks after delivery (lactation), 226 and 262 breast milk (BM) samples were analysed for AFM1 and OTA respectively by ELISA. The association of demographics and food consumption with mycotoxins was evaluated using multivariable logistic regression. In HIV-infected, urinary AFM1 was detected in 46/94 (Median: 0.05; Range: 0.04-0.46 ng mL-1) in pregnancy and 47/66 (Median: 0.05; Range: 0.04-1.01 ng mL-1) post-lactation. Urinary FB1 was detected in 86/94 (Median: 1.39; Range: 0.17-6.02 ng mL-1) in pregnancy and 56/66 (Median: 0.72; Range: 0.20-3.81 ng mL-1) post-lactation. BM AFM1 was detected in 28/110 (Median: 7.24; Range: 5.96-29.80 pg mL-1) and OTA in 11/129 (Median: 0.20; Range: 0.14-0.65 ng mL-1). In HIV-uninfected, urinary AFM1 was detected in 48/81 (Median: 0.05; Range: 0.04-1.06 ng mL-1) in pregnancy and 41/59 (Median: 0.05; Range: 0.04-0.52 ng mL-1) post-lactation. Urinary FB1 was detected in 74/81 (Median: 1.15; Range: 0.17-6.16 ng mL-1) in pregnancy and 55/59 (Median: 0.96; Range: 0.20-2.82 ng mL-1) post-lactation. BM AFM1 was detected in 38/116 (Median: 7.70; Range: 6.07-31.75 pg mL-1) and OTA in 4/133 (Median: 0.24; Range: 0.18-0.83 ng mL-1). Location, wealth, and peanut butter consumption were determinants of AFB1 exposure. HIV infection, BMI, location, rainy season, unemployment, and age were determinants of FB1 exposure. Women especially those pregnant and/or HIV-infected are at risk of adverse effects of mycotoxins.
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Affiliation(s)
- Tatenda Clive Murashiki
- Immunology Unit, Department of Laboratory Diagnostic and Investigative Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Arthur John Mazhandu
- Immunology Unit, Department of Laboratory Diagnostic and Investigative Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Rutendo B L Zinyama-Gutsire
- Immunology Unit, Department of Laboratory Diagnostic and Investigative Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Isaac Mutingwende
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Lovemore Ronald Mazengera
- Immunology Unit, Department of Laboratory Diagnostic and Investigative Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Kerina Duri
- Immunology Unit, Department of Laboratory Diagnostic and Investigative Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Osoro E, Awuor AO, Inwani I, Mugo C, Hunsperger E, Verani JR, Nduati R, Kinuthia J, Okutoyi L, Mwaengo D, Maugo B, Otieno NA, Mirieri H, Ombok C, Nyawanda B, Agogo GO, Ngere I, Zitomer NC, Rybak ME, Munyua P, Njenga K, Widdowson MA. Association between low maternal serum aflatoxin B1 exposure and adverse pregnancy outcomes in Mombasa, Kenya, 2017-2019: A nested matched case-control study. MATERNAL & CHILD NUTRITION 2024:e13688. [PMID: 38886171 DOI: 10.1111/mcn.13688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/20/2024]
Abstract
We examined the association between serum aflatoxin B1-lysine adduct (AFB1-lys) levels in pregnant women and adverse pregnancy outcomes (low birthweight, miscarriage and stillbirth) through a nested matched case-control study of pregnant women enroled at ≤28 weeks' gestation in Mombasa, Kenya, from 2017 to 2019. Cases comprised women with an adverse birth outcome, defined as either delivery of a singleton infant weighing <2500 g, or a miscarriage, or a stillbirth, while controls were women who delivered a singleton live infant with a birthweight of ≥2500 g. Cases were matched to controls at a ratio of 1:2 based on maternal age at enrolment, gestational age at enrolment and study site. The primary exposure was serum AFB1-lys. The study included 125 cases and 250 controls. The median gestation age when serum samples were collected was 23.0 weeks (interquartile range [IQR]: 18.1-26.0) and 23.5 (IQR: 18.1-26.5) among cases and controls, respectively. Of the 375 tested sera, 145 (38.7%) had detectable serum AFB1-lys: 36.0% in cases and 40.0% in controls. AFB1-lys adduct levels were not associated with adverse birth outcomes on multivariable analysis. Mid-upper arm circumference was associated with a 6% lower odds of adverse birth outcome for every unit increase (p = 0.023). Two-fifths of pregnant women had detectable levels of aflatoxin midway through pregnancy. However, we did not detect an association with adverse pregnancy outcomes, likely because of low serum AFB1-lys levels and low power, restricting meaningful comparison. More research is needed to understand the public health risk of aflatoxin in pregnant women to unborn children.
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Affiliation(s)
- Eric Osoro
- Washington State University Global Health Kenya, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Abigael O Awuor
- Washington State University Global Health Kenya, Nairobi, Kenya
- U.S. Centers for Disease Control and Prevention, CDC Kenya, Division of Global Health Protection, Nairobi, Kenya
| | - Irene Inwani
- Department of Paediatrics and Child Health/Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Cyrus Mugo
- Research and Programs Department, Kenyatta National Hospital/University of Nairobi, Nairobi, Kenya
| | - Elizabeth Hunsperger
- U.S. Centers for Disease Control and Prevention, CDC Kenya, Division of Global Health Protection, Nairobi, Kenya
| | - Jennifer R Verani
- U.S. Centers for Disease Control and Prevention, CDC Kenya, Division of Global Health Protection, Nairobi, Kenya
| | - Ruth Nduati
- Department of Paediatrics and Child Health/Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - John Kinuthia
- Research and Programs Department, Kenyatta National Hospital/University of Nairobi, Nairobi, Kenya
| | - Lydia Okutoyi
- Department of Obstetrics and Gynaecology/Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Dufton Mwaengo
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Brian Maugo
- Department of Paediatrics and Child Health/Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Nancy A Otieno
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Harriet Mirieri
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Cynthia Ombok
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Bryan Nyawanda
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - George O Agogo
- U.S. Centers for Disease Control and Prevention, CDC Kenya, Division of Global Health Protection, Nairobi, Kenya
| | - Isaac Ngere
- Washington State University Global Health Kenya, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Nicholas C Zitomer
- National Center for Environmental Health, U.S. Centers for Disease Control and Prevention, Division of Laboratory Sciences, Atlanta, Georgia, USA
| | - Michael E Rybak
- National Center for Environmental Health, U.S. Centers for Disease Control and Prevention, Division of Laboratory Sciences, Atlanta, Georgia, USA
| | - Peninah Munyua
- U.S. Centers for Disease Control and Prevention, CDC Kenya, Division of Global Health Protection, Nairobi, Kenya
| | - Kariuki Njenga
- Washington State University Global Health Kenya, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Marc-Alain Widdowson
- U.S. Centers for Disease Control and Prevention, CDC Kenya, Division of Global Health Protection, Nairobi, Kenya
- Institute of Tropical Medicine, Antwerp, Belgium
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Hassen JY, Debella A, Eyeberu A, Mussa I. Level of exposure to aflatoxins during pregnancy and its association with adverse birth outcomes in Africa: a meta-analysis. Int Health 2024:ihae015. [PMID: 38339961 DOI: 10.1093/inthealth/ihae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/28/2023] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Aflatoxins are various poisonous carcinogens and mutagens produced by Aspergillus species. Exposure to aflatoxins during pregnancy results in adverse birth outcomes. This meta-analysis was carried out to determine the estimates of how much aflatoxin is harmful to the pregnancy and its outcome, including birthweight, birth length, low birthweight (LBW), small for gestational age (SGA), stunting, poverty, food insecurity, income, pesticides and stillbirth, in an African context. METHODS Both published and unpublished studies in Africa were searched on MEDLINE, PubMed, Embase, SCOPUS, Web of Science and Google Scholar. Stata version 18.2 software was used for cleaning and analysis. The prevalence with a 95% confidence interval (CI) was estimated using the random effects model and a forest plot was used to present the findings. In addition, the heterogeneity of the study was assessed using Cochrane I2 statistics and publication bias was assessed using Egger's intercept and funnel plot. RESULTS This review included 28 studies with a total of 6283 pregnant women and newborns. The analysis showed the overall level of exposure to aflatoxins was 64% (95% CI 48 to 78, τ2=0.66, I2=99.34%, p=0.001). In the subgroup analysis by publication year, the highest level of exposure to aflatoxins (82% [95% CI 69 to 92]) was observed among studies published from 2020 to 2023. This study also found that exposure to aflatoxins during pregnancy had an association with prematurity, LBW, SGA and stillbirth. CONCLUSIONS The data analysed in this study indicated that three of every five pregnant women had exposure to aflatoxins in Africa. Moreover, pregnant women exposed to aflatoxins had a higher likelihood of having a LBW and SGA newborn. Thus governments and all stakeholders should initiate policies that mitigate the toxicity of aflatoxins in pregnant women, foetuses and newborns.
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Affiliation(s)
- Jemal Y Hassen
- School of Rural Development and Agricultural Innovation, Haramaya University, Dire Dawa, Ethiopia
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addis Eyeberu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Ibsa Mussa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Tong Y, Tonui P, Orang'o O, Zhang J, Maina T, Muthoka K, Groopman J, Smith J, Madeen E, Ermel A, Loehrer P, Brown DR. Association of plasma aflatoxin with persistent detection of oncogenic human papillomaviruses in cervical samples from Kenyan women enrolled in a longitudinal study. BMC Infect Dis 2023; 23:377. [PMID: 37280534 DOI: 10.1186/s12879-023-08323-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/11/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Cervical cancer is caused by oncogenic human papillomaviruses (HR-HPV) and is common among Kenyan women. Identification of factors that increase HR-HPV persistence is critically important. Kenyan women exposed to aflatoxin have an increased risk of HR-HPV detection in cervical specimens. This analysis was performed to examine associations between aflatoxin and HR-HPV persistence. METHODS Kenyan women were enrolled in a prospective study. The analytical cohort for this analysis included 67 HIV-uninfected women (mean age 34 years) who completed at least two of three annual study visits and had an available blood sample. Plasma aflatoxin was detected using ultra-high pressure liquid chromatography (UHPLC)-isotope dilution mass spectrometry. Annual cervical swabs were tested for HPV (Roche Linear Array). Ordinal logistic regression models were fitted to examine associations of aflatoxin and HPV persistence. RESULTS Aflatoxin was detected in 59.7% of women and was associated with higher risk of persistent detection of any HPV type (OR = 3.03, 95%CI = 1.08-8.55, P = 0.036), HR-HPV types (OR = 3.63, 95%CI = 1.30-10.13, P = 0.014), and HR-HPV types not included in the 9-valent HPV vaccine (OR = 4.46, 95%CI = 1.13-17.58, P = 0.032). CONCLUSIONS Aflatoxin detection was associated with increased risk of HR-HPV persistence in Kenyan women. Further studies, including mechanistic studies are needed to determine if aflatoxin synergistically interacts with HR-HPV to increase cervical cancer risk.
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Affiliation(s)
- Yan Tong
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine and Fairbanks School of Public Health, Indianapolis, IN, 46204, USA
| | - Philip Tonui
- Department of Reproductive Health, Moi University, Eldoret, Kenya
| | - Omenge Orang'o
- Department of Reproductive Health, Moi University, Eldoret, Kenya
| | - Jianjun Zhang
- Department of Epidemiology, Fairbanks School of Public Health, Indiana University, Indianapolis, IN, 46204, USA
| | - Titus Maina
- Department of Molecular Biology, Maseno University, Maseno, Kenya
| | - Kapten Muthoka
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - John Groopman
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Joshua Smith
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Erin Madeen
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Aaron Ermel
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, 46204, USA
| | - Patrick Loehrer
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, 46204, USA
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, 46204, USA
| | - Darron R Brown
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, 46204, USA.
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, 46204, USA.
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN, 46204, USA.
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Alonso S, Angel MD, Muunda E, Kilonzi E, Palloni G, Grace D, Leroy JL. Consumer Demand for Milk and the Informal Dairy Sector Amidst COVID-19 in Nairobi, Kenya. Curr Dev Nutr 2023; 7:100058. [PMID: 36950195 PMCID: PMC9957657 DOI: 10.1016/j.cdnut.2023.100058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 01/05/2023] [Accepted: 02/10/2023] [Indexed: 03/24/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has had large negative effects on countries' economies and individual well-being throughout the world, particularly in low- and middle-income countries. Pandemic-related changes in behavior and government restrictions in Kenya may have negatively affected food supply chains and household food access; however, the empirical evidence is currently limited. Objectives The study explored changes in informal milk markets, dairy consumption, and food insecurity among low-income households in urban and periurban Nairobi, Kenya, following the start of the COVID-19 pandemic in the country. Methods Baseline data on milk sales and consumption were collected in late 2019 from dairy vendors operating in the informal sector and their dairy customers. We conducted 2 longitudinal telephone surveys with the same study participants in July and September-October 2020, respectively. Results At the first follow-up, the volume of milk sold by informal vendors had dropped by 30% compared with their baseline level, and the volume of milk from informal markets consumed by households decreased by 23%. By the second follow-up, the volume of milk sold and consumed had recovered somewhat but remained lower than the volume observed 1 y prior in the same season. Large reductions in the consumption of other animal-sourced products were also observed. The rate of food insecurity increased by 16 and 11 percentage points in the first and second follow-up periods, respectively, compared with baseline. Conclusions The evidence, therefore, suggests that the timing of the pandemic and the related restrictions were associated with a decrease in the supply and consumption of milk from informal markets in Nairobi and a decrease in the food security of periurban consumers.
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Affiliation(s)
- Silvia Alonso
- Animal and Human Health Program, International Livestock Research Institute, Addis Ababa, Ethiopia
| | - Moira Donahue Angel
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington DC, United States
| | - Emmanuel Muunda
- Animal and Human Health Program, International Livestock Research Institute, Nairobi, Kenya
| | - Emily Kilonzi
- Animal and Human Health Program, International Livestock Research Institute, Nairobi, Kenya
| | - Giordano Palloni
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington DC, United States
| | - Delia Grace
- Animal and Human Health Program, International Livestock Research Institute, Nairobi, Kenya
- Food and Markets Department, Natural Resources Institute, University of Greenwich, United Kingdom
| | - Jef L Leroy
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington DC, United States
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Ogallo IO, Kaindi DWM, Abong GO, Mwangi AM. Dietary aflatoxin exposure of lactating mothers of children 0-6 months in Makueni County, Kenya. MATERNAL & CHILD NUTRITION 2023:e13493. [PMID: 36814005 DOI: 10.1111/mcn.13493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 01/29/2023] [Accepted: 02/01/2023] [Indexed: 02/24/2023]
Abstract
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.
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Affiliation(s)
- Isaac O Ogallo
- Faculty of Agriculture, Department of Food, Science, Nutrition & Technology, Applied Human Nutrition Program, University of Nairobi, Nairobi, Kenya.,Department of International Agricultural Development, Graduate School of International Food and Agricultural Studies, Tropical Crop Science, Master Program, Tokyo University of Agriculture, Tokyo, Japan
| | - Dasel W M Kaindi
- Faculty of Agriculture, Department of Food, Science, Nutrition & Technology, Applied Human Nutrition Program, University of Nairobi, Nairobi, Kenya
| | - George O Abong
- Faculty of Agriculture, Department of Food, Science, Nutrition & Technology, University of Nairobi, Nairobi, Kenya
| | - Alice M Mwangi
- Faculty of Agriculture, Department of Food, Science, Nutrition & Technology, Applied Human Nutrition Program, University of Nairobi, Nairobi, Kenya.,Udugu, Ufanisi Ustawi wa Jamii (3UJ) Development Limited, Nairobi, Kenya
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Tong Y, Tonui P, Orang'o O, Zhang J, Maina T, Muthoka K, Groopman J, Smith J, Madeen E, Ermel A, Loehrer P, Brown D. Association of Plasma Aflatoxin With Persistent Detection of Oncogenic Human Papillomaviruses in Cervical Samples From Kenyan Women Enrolled in a Longitudinal Study. RESEARCH SQUARE 2023:rs.3.rs-2468599. [PMID: 36747756 PMCID: PMC9901024 DOI: 10.21203/rs.3.rs-2468599/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background Cervical cancer is common among Kenyan women and is caused by oncogenic human papillomaviruses (HR-HPV). Identification of factors that increase HR-HPV persistence is critically important. Kenyan women exposed to aflatoxin have an increased risk of cervical HR-HPV detection. This analysis was performed to examine associations between aflatoxin and HR-HPV persistence. Methods Kenyan women were enrolled in a prospective study. The analytical cohort for this analysis included 67 HIV-uninfected women (mean age 34 years) who completed at least two of three annual study visits and had an available blood sample. Plasma aflatoxin was detected using ultra-high pressure liquid chromatography (UHPLC)-isotope dilution mass spectrometry. Annual cervical swabs were tested for HPV (Roche Linear Array). Ordinal logistic regression models were fitted to examine associations of aflatoxin and HPV persistence. Results Aflatoxin was detected in 59.7% of women and was associated with higher risk of persistent detection of any HPV type (OR = 3.03, 95%CI = 1.08-8.55, P = 0.036), HR-HPV types (OR = 3.63, 95%CI = 1.30-10.13, P = 0.014), and HR-HPV types not included in the 9-valent HPV vaccine (OR = 4.46, 95%CI = 1.13-17.58, P = 0.032). Conclusions Aflatoxin detection was associated with increased risk of HR-HPV persistence in Kenyan women. Further studies are needed to determine if aflatoxin synergistically interacts with HR-HPV to increase cervical cancer risk.
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Affiliation(s)
- Yan Tong
- Indiana University School of Medicine
| | | | | | | | | | | | | | | | - Erin Madeen
- Johns Hopkins Bloomberg School of Public Health
| | | | - Patrick Loehrer
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center
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Abstract
Gallbladder cancer (GBC) is the most common cancer of the biliary tract, characterized by a very poor prognosis when diagnosed at advanced stages owing to its aggressive behaviour and limited therapeutic options. Early detection at a curable stage remains challenging because patients rarely exhibit symptoms; indeed, most GBCs are discovered incidentally following cholecystectomy for symptomatic gallbladder stones. Long-standing chronic inflammation is an important driver of GBC, regardless of the lithiasic or non-lithiasic origin. Advances in omics technologies have provided a deeper understanding of GBC pathogenesis, uncovering mechanisms associated with inflammation-driven tumour initiation and progression. Surgical resection is the only treatment with curative intent for GBC but very few cases are suitable for resection and most adjuvant therapy has a very low response rate. Several unmet clinical needs require to be addressed to improve GBC management, including discovery and validation of reliable biomarkers for screening, therapy selection and prognosis. Standardization of preneoplastic and neoplastic lesion nomenclature, as well as surgical specimen processing and sampling, now provides reproducible and comparable research data that provide a basis for identifying and implementing early detection strategies and improving drug discovery. Advances in the understanding of next-generation sequencing, multidisciplinary care for GBC, neoadjuvant and adjuvant strategies, and novel systemic therapies including chemotherapy and immunotherapies are gradually changing the treatment paradigm and prognosis of this recalcitrant cancer.
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Affiliation(s)
- Juan C Roa
- Department of Pathology, Millennium Institute on Immunology and Immunotherapy, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Patricia García
- Department of Pathology, Millennium Institute on Immunology and Immunotherapy, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Vinay K Kapoor
- Department of Hepato-pancreato-biliary (HPB) Surgery, Mahatma Gandhi Medical College & Hospital (MGMCH), Jaipur, India
| | - Shishir K Maithel
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Milind Javle
- Department of Gastrointestinal Medical Oncology, UT M.D. Anderson Cancer Center, Houston, TX, USA
| | - Jill Koshiol
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
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Urinary Aflatoxin M1 Concentration and Its Determinants in School-Age Children in Southern Ethiopia. Nutrients 2022; 14:nu14132580. [PMID: 35807760 PMCID: PMC9268381 DOI: 10.3390/nu14132580] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/14/2022] [Accepted: 06/18/2022] [Indexed: 12/14/2022] Open
Abstract
Aflatoxins are mycotoxins that can contaminate grains, legumes, and oil seeds. These toxic compounds are an especially serious problem in tropical and sub-tropical climates. The objective of this study was to raise awareness of aflatoxin exposure among primary school children in Shebedino woreda, southern Ethiopia, by measuring urinary aflatoxin M1 (AFM1). The study employed a cross-sectional design and systematic random sampling of children from eight schools in the district. The mean ± SD age of the children was 9.0 ± 1.8 years. Most (84.6%) households were food insecure with 17.9% severely food insecure. Urinary AFM1 was detected in more than 93% of the children. The median [IQR] concentration of AFM1/Creat was 480 [203, 1085] pg/mg. Based on a multiple regression analysis: DDS, consumption of haricot bean or milk, source of drinking water, maternal education, and household food insecurity access scale scores were significantly associated with urinary AFM1/Creat. In conclusion, a high prevalence of urinary AFM1 was observed in this study. However, the relation between AFM1 and dietary intake was analyzed based on self-reported dietary data; hence, all of the staple foods as well as animal feeds in the study area should be assessed for aflatoxin contamination.
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Ashraf W, Rehman A, Ahmad MUD, Rabbani M, Mushtaq MH, Aamir K, Xue KS, Wang JS. Assessment of aflatoxin B 1-lysine adduct in children and its effect on child growth in Lahore, Pakistan. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2022; 39:1463-1473. [PMID: 35652855 DOI: 10.1080/19440049.2022.2080871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Aflatoxin B1 is an important toxic food contaminant and there is very little information available about its exposure and effects on the health of the Pakistani population. Therefore, children (n = 238) aged 1-11 years were recruited in this study to estimate the levels of aflatoxin B1-lysine adduct and to measure its adverse effects on growth. Blood samples were analyzed to detect AFB1-lysine adducts through high-performance liquid chromatography. Socio-demographic information and anthropometry measurements were also obtained. All participants had detectable levels of AFB1-lysine adduct with a median concentration of 10.66 pg/mg albumin (95% CI: 8.6-12.4). Differences in area of residence (p < 0.05) and the father's employment (p < 0.05) were significant predictors for aflatoxin concentration levels in ordinary least square and quantile regression models (residence in 75th quantile and father employment in 90th quantile). Children aged from 5 to 11 years in the 5th and 90th quantiles of the regression model had a significant association with aflatoxin levels. A very high (50.4%, 120/238) prevalence of growth impairment (stunting, wasting, and underweight) was also observed in this study. Although we couldn't establish the effect of aflatoxin on growth impairment, children with low serum albumin levels (OR = 0.18; 95% CI: 0.05-0.56; p = 0.004) were likely to be at risk of wasting. Also, low birth weight was strongly associated with wasting (OR = 3.11; 95% CI: 1.36-7.03; p = 0.006) and underweight (OR = 4.60; 95% CI: 2.21-10.05; p= <0.001), while the mother's school level education had a correlation with child stunting (OR = 1.84; 95% CI: 1.07-3.22; p = 0.029). The high prevalence of growth impairment and high concentration of serum AFB1-lysine adduct levels in study participants demand immediate efforts to mitigate the adverse health outcomes in children in Pakistan.
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Affiliation(s)
- Waseela Ashraf
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan.,Department of Environmental Health Science, The University of Georgia, Athens, GA, USA
| | - Abdul Rehman
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Mansur-Ud-Din Ahmad
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Masood Rabbani
- Institute of Microbiology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Hassan Mushtaq
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Khalida Aamir
- Department of Preventive Pediatric Medicine, The Children's Hospital and The Institute of Child Health, Lahore, Pakistan
| | - Kathy S Xue
- Department of Environmental Health Science, The University of Georgia, Athens, GA, USA
| | - Jia-Sheng Wang
- Department of Environmental Health Science, The University of Georgia, Athens, GA, USA
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Ayele M, Haile D, Alonso S, Sime H, Abera A, Balcha KH, Roba KT, Guma GT, Endris BS. Aflatoxin exposure among children of age 12-59 Months in Butajira District, South-Central Ethiopia: a community based cross-sectional study. BMC Pediatr 2022; 22:326. [PMID: 35655154 PMCID: PMC9161506 DOI: 10.1186/s12887-022-03389-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 05/25/2022] [Indexed: 11/25/2022] Open
Abstract
Background The continued provision of safe food, free of aflatoxin remains a huge challenge in developing countries. Despite several favourable climatic conditions that facilitate aflatoxin contamination in Ethiopia, there is little information showing aflatoxin exposure in children. Therefore, this study assessed aflatoxin exposure among young children in Butajira district, South-Central Ethiopia. Methods Community based cross-sectional study stratified by agro-ecology was employed in Health and Demographic Surveillance Site (HDSS) of Butajira. The study included 332 children aged 12–59 months and were selected by simple random sampling technique using the HDSS registration number as a sampling frame. We collected data on dietary practice and aflatoxin exposure. Aflatoxin M1 concentration in urine was measured by Enzyme-Linked Immunosorbent assay (ELISA). The data analysis was carried out using STATA. Results Detectable urinary Aflatoxin M1 was found in 62.4% (95% CI: 56.9 – 67.5%) of the children at a level ranging from 0.15 to 0.4 ng/ml. Children living in lowland agro-ecological zone had [AOR = 2.11 (95% CI; 1.15, 3.88] odds of being exposed to aflatoxin as compared to children living in highland agro-ecological zone. Children at lower socio-economic status [AOR = 0.27 (95% CI; 0.14, 0.50] and medium socio-economic status [AOR = 0.47 (95% CI; 0.25, 0.87] had 73% and 53% lower odds of being exposed to aflatoxin as compared to children in the higher socio-economic status, respectively. Conclusions Aflatoxin exposure among young children was very high in South-Central Ethiopia. This high aflatoxin exposure might emphasize the need for aflatoxin exposure mitigation strategies in Ethiopia. Especially, raising awareness of the community towards aflatoxin exposure is very crucial. In addition, further research is required to assess long-term aflatoxin exposure and its association with child growth and development.
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Affiliation(s)
- Mary Ayele
- Doctors With Africa CUAMM, Medici Con L'Africa, Cuamm, Ethiopia.
| | - Demewoz Haile
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Silvia Alonso
- Animal and Human Health Program, International Livestock Research Institute, Addis Ababa, Ethiopia
| | - Heven Sime
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Adugna Abera
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Kifle Habte Balcha
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Kedir Teji Roba
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Geremew Tasew Guma
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Bilal Shikur Endris
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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12
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Wangia-Dixon RN, Quach THT, Song X, Ombaka J, Githanga DP, Anzala OA, Wang JS. Determinants of aflatoxin exposures in Kenyan School-aged children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2022; 32:1183-1191. [PMID: 33256462 DOI: 10.1080/09603123.2020.1854192] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 11/18/2020] [Indexed: 06/12/2023]
Abstract
Aflatoxins are naturally occurring food toxins known to contaminate cereals with a carry-over effect in milk and meat products from farm animals raised on contaminated feed. In children, continuous consumption of aflatoxin-contaminated food is linked to immune suppression, vaccine interference and growth faltering while in adult populations, carcinogenesis in the liver has been established. We evaluate the main determinants of aflatoxin exposures among children recruited from primary schools in Makueni and Siaya Counties. A five-part questionnaire was administered to collect information from randomly selected participants. AflatoxinB1-lysine adducts in children's sera and total aflatoxins in food samples were analyzed by High-Performance Liquid Chromatography with Fluorescence detection. Using Chi-squared tests and Kruskal-Wallis tests, children from low-income households had the highest aflatoxin exposure, p-value = 0.0029. Smaller family size, greater food diversity, and good farming practices were associated with low aflatoxin exposures p < 0.001. Individual households living under severe levels of poverty were evidently exposed to higher levels of aflatoxins.
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Affiliation(s)
- Ruth Nabwire Wangia-Dixon
- Department of Environmental Health Science, University of Georgia, Athens, USA
- KAVI Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Trang Ho Thu Quach
- Faculty of Pharmacy, Ho Chi Minh City University of Technology (HUTECH), Vietnam
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, USA
| | - Xiao Song
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, USA
| | - James Ombaka
- School of Public Health and Community Development, Maseno University, Maseno, Kenya
| | - David Peter Githanga
- Nairobi Hospital, Hospital Road, Nairobi, Kenya
- Medical Microbiology Department, University of Nairobi Nairobi, Kenya
| | - Omu Aggrey Anzala
- KAVI Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
- Nairobi Hospital, Hospital Road, Nairobi, Kenya
- Medical Microbiology Department, University of Nairobi Nairobi, Kenya
| | - Jia-Sheng Wang
- Department of Environmental Health Science, University of Georgia, Athens, USA
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Tesfamariam K, Argaw A, Hanley-Cook GT, Gebreyesus SH, Kolsteren P, Belachew T, Van de Velde M, De Saeger S, De Boevre M, Lachat C. Multiple mycotoxin exposure during pregnancy and risks of adverse birth outcomes: a prospective cohort study in rural Ethiopia. ENVIRONMENT INTERNATIONAL 2022; 160:107052. [PMID: 34952355 DOI: 10.1016/j.envint.2021.107052] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Mycotoxin exposure during pregnancy has been associated with adverse birth outcomes in low- and middle-income countries. The evidence, however, is inconsistent and mainly limited to the assessment of a single mycotoxin. We assessed biomarkers of exposure to multiple mycotoxins during pregnancy and their associations with adverse birth outcomes in rural Ethiopia. METHODS We analyzed data from 579 pregnant women between 8 and 24 weeks of completed gestation enrolled in a prospective cohort study. Serum mycotoxin concentrations were determined using liquid chromatography coupled with tandem mass spectrometry. Multivariable linear probability models, adjusted for potential confounding factors and multiple comparisons, were fitted to assess the associations between mycotoxin exposure and small for gestational age and preterm birth. We applied principal component analysis to reduce the dimensionality of biomarker data from several taxonomic mycotoxin groups. RESULTS All pregnant women were co-exposed to at least five mycotoxins, and one pregnant woman was co-exposed to 27 mycotoxins. Fumonisins (FB), i.e., FB2, FB3, FB1, and tenuazonic acid were the most frequently identified mycotoxins in 98.8, 95.3, 93.3, and 81.4% of the samples respectively. Deoxynivalenol was detected in 38.7%, nivalenol in 50.1%, ochratoxin α in 67.9%, and zearalenone in 50.9% of the serum samples. After adjustment, we found no statistically significant (all P ≥ 0.05) associations between mycotoxin exposures and birth outcomes. CONCLUSIONS Despite our study providing no evidence for relationships between mycotoxin biomarkers and adverse birth outcomes, our findings do indicate an extensive presence of multiple mycotoxin exposure among pregnant women. Public health policies and nutrition-sensitive interventions must ensure exposure to mycotoxins is reduced in rural Ethiopia.
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Affiliation(s)
- Kokeb Tesfamariam
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium; Department of Public Health, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia; Center of Excellence in Mycotoxicology and Public Health, Faculty of Pharmaceutical Sciences, Ghent University, MYTOX-SOUTH® Coordination Unit, Ghent, Belgium; Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Alemayehu Argaw
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium; Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Giles T Hanley-Cook
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Seifu H Gebreyesus
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Tefera Belachew
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Mario Van de Velde
- Center of Excellence in Mycotoxicology and Public Health, Faculty of Pharmaceutical Sciences, Ghent University, MYTOX-SOUTH® Coordination Unit, Ghent, Belgium
| | - Sarah De Saeger
- Center of Excellence in Mycotoxicology and Public Health, Faculty of Pharmaceutical Sciences, Ghent University, MYTOX-SOUTH® Coordination Unit, Ghent, Belgium; Department of Biotechnology and Food Technology, Faculty of Science, University of Johannesburg, Doornfontein Campus, Gauteng, South Africa
| | - Marthe De Boevre
- Center of Excellence in Mycotoxicology and Public Health, Faculty of Pharmaceutical Sciences, Ghent University, MYTOX-SOUTH® Coordination Unit, Ghent, Belgium
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium.
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14
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Lesuuda L, Obonyo MA, Cheserek MJ. Determinants of knowledge about aflatoxin and fumonisin contamination in sorghum and postharvest practices among caregivers of children aged 6-59 months in Kerio Valley, Kenya. Food Sci Nutr 2021; 9:5435-5447. [PMID: 34646514 PMCID: PMC8498054 DOI: 10.1002/fsn3.2502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022] Open
Abstract
Stunting among children under five years old is still a problem in many developing countries including Kenya. However, there is little information linking stunting with mycotoxin contamination of complementary foods. The aim of this study was to assess knowledge about aflatoxin and fumonisin contamination in sorghum alongside postharvest handling and storage practices among caregivers of children under five years old in Kerio Valley, Kenya. A cross-sectional study was conducted to obtain data from 353 randomly selected caregivers of children aged 6-59 months. Qualitative data were obtained through Focus Group Discussions and Key Informant Interviews. Overall, majority of the caregivers of young children had poor knowledge (61.8%) about mycotoxin contamination of food, and poor postharvest handling and storage practices (74.5%). The caregiver's knowledge about mycotoxins was significantly associated with age [(AOR=4.629, (95% Cl: 2.530-8.472), p < .001], education level [(AOR=0.275, (95% Cl: 0.088-0.434), p = .001], marital status [(AOR=15.187, (95% Cl: 1.830-126.007), p = .012], and household monthly income [(AOR=2.623, (95% Cl: 1.550-4.439), p < 0,001]. Furthermore, the caregiver's age [(AOR=3.845, (95% Cl: 1.558-9.490), p = .003], education level [(AOR=0.196, (95% Cl: 0.088-0.434), p < .001], monthly income [(AOR=3.291, (95% Cl: 1.550-6.986), p = .002], and knowledge on mycotoxin contamination of sorghum [AOR, 5.428 (95% Cl: 2.855-10.319), p < .001] were significantly associated with postharvest handling and storage practices except for marital status [AOR, 3.579 (95% Cl: 0.403-31.775), p = .252]. In conclusion, caregivers of young children had poor knowledge about mycotoxin contamination of complementary foods and suboptimal postharvest handling and storage practices of sorghum. This increases the risk of mycotoxin exposure to young children and necessitates mitigation measures including sensitization campaigns and social behavior change communication.
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Affiliation(s)
- Lmeriai Lesuuda
- Department of Human NutritionFaculty of Health SciencesEgerton UniversityEgertonKenya
| | - Meshack Amos Obonyo
- Department of Biochemistry and Molecular BiologyFaculty of ScienceEgerton UniversityEgertonKenya
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15
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Wenndt AJ, Sudini HK, Mehta R, Pingali P, Nelson R. Spatiotemporal assessment of post-harvest mycotoxin contamination in rural North Indian food systems. Food Control 2021; 126:108071. [PMID: 34345120 PMCID: PMC8075802 DOI: 10.1016/j.foodcont.2021.108071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 03/05/2021] [Accepted: 03/06/2021] [Indexed: 11/17/2022]
Abstract
The spatiotemporal trends in aflatoxin B1 (AFB1), fumonisin B1 (FB1), and deoxynivalenol (DON) accumulation were analyzed in a range of food commodities (maize, groundnut, pearl millet, rice, and wheat) in village settings in Unnao, Uttar Pradesh, India. Samples (n = 1549) were collected across six communities and six time points spanning a calendar year and were analyzed for mycotoxins using enzyme-linked immunosorbent assays. AFB1 and FB1 were common across surveyed villages, with moderate to high detection rates (45-75%) observed across commodities. AFB1 levels in maize and groundnuts and FB1 levels in maize and pearl millet frequently exceeded regulatory threshold levels of 15 μg/kg (AFB1) and 2 μg/g (FB1). DON was analyzed in wheat, with 3% of samples yielding detectable levels and none exceeding 1 μg/g. In rice, AFB1 levels were highest in the bran and husk and lower in the kernel. Commodity type significantly influenced AFB1 detection status, while commodity type, season, and visual quality influenced samples' legal status. Storage characteristics and household socioeconomic status indicators did not have significant effects on contamination. No significant effects of any variables on FB1 detection or legal status were observed. Data on mycotoxin contamination, combined with data on local dietary intake, were used to estimate spatiotemporal mycotoxin exposure profiles. Estimated seasonal per capita exposure levels for AFB1 (5.4-39.3 ng/kg body weight/day) and FB1 (~0-2.4 μg/kg body weight/day) exceeded provisional maximum tolerable daily intake levels (1 ng/kg body weight/day for AFB1 and 2 μg/kg body weight/day for FB1) in some seasons and locations. This study demonstrates substantial dietary mycotoxin exposure risk in Unnao food systems and serves as an evidentiary foundation for participatory food safety intervention in the region.
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Affiliation(s)
- Anthony J. Wenndt
- School of Integrative Plant Sciences, Cornell University, Ithaca, NY, USA
- Tata Cornell Institute for Agriculture & Nutrition, Cornell University, Ithaca, NY, USA
| | - Hari Kishan Sudini
- International Crops Research Institute for the Semi-Arid Tropics, Patancheru, Telangana, India
| | - Rukshan Mehta
- Nutrition & Health Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Prabhu Pingali
- Tata Cornell Institute for Agriculture & Nutrition, Cornell University, Ithaca, NY, USA
- Charles H. Dyson School of Applied Economics & Management, Cornell University, Ithaca, NY, USA
| | - Rebecca Nelson
- School of Integrative Plant Sciences, Cornell University, Ithaca, NY, USA
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16
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Abstract
Aflatoxins are endemic in Kenya. The 2004 outbreak of acute aflatoxicosis in the country was one of the unprecedented epidemics of human aflatoxin poisoning recorded in mycotoxin history. In this study, an elaborate review was performed to synthesize Kenya’s major findings in relation to aflatoxins, their prevalence, detection, quantification, exposure assessment, prevention, and management in various matrices. Data retrieved indicate that the toxins are primarily biosynthesized by Aspergillus flavus and A. parasiticus, with the eastern part of the country reportedly more aflatoxin-prone. Aflatoxins have been reported in maize and maize products (Busaa, chan’gaa, githeri, irio, muthokoi, uji, and ugali), peanuts and its products, rice, cassava, sorghum, millet, yams, beers, dried fish, animal feeds, dairy and herbal products, and sometimes in tandem with other mycotoxins. The highest total aflatoxin concentration of 58,000 μg/kg has been reported in maize. At least 500 acute human illnesses and 200 deaths due to aflatoxins have been reported. The causes and prevalence of aflatoxins have been grossly ascribed to poor agronomic practices, low education levels, and inadequate statutory regulation and sensitization. Low diet diversity has aggravated exposure to aflatoxins in Kenya because maize as a dietetic staple is aflatoxin-prone. Detection and surveillance are only barely adequate, though some exposure assessments have been conducted. There is a need to widen diet diversity as a measure of reducing exposure due to consumption of aflatoxin-contaminated foods.
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Zitomer NC, Awuor AO, Widdowson MA, Daniel JH, Sternberg MR, Rybak ME, Mbidde EK. Human aflatoxin exposure in Uganda: Estimates from a subset of the 2011 Uganda AIDS indicator survey (UAIS). Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2020; 38:136-147. [PMID: 33216708 DOI: 10.1080/19440049.2020.1825826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Aflatoxins are carcinogenic mycotoxins that contaminate a variety of crops worldwide. Acute exposure can cause liver failure, and chronic exposure can lead to stunting in children and liver cancer in adults. We estimated aflatoxin exposure across Uganda by measuring a serum biomarker of aflatoxin exposure in a subsample from the 2011 Uganda AIDS Indicator Survey, a nationally representative survey of HIV prevalence, and examined its association with geographic, demographic, and socioeconomic variables. We analysed a subsample of 985 serum specimens selected among HIV-negative participants from 10 survey-defined geographic regions for serum aflatoxin B1-lysine (AFB1-lys) by use of isotope dilution LC-MS/MS and calculated results normalised to serum albumin. We used statistical techniques for censored data to estimate geometric means (GMs), standard deviations, and percentiles. We detected serum AFB1-lys in 71.7% of specimens (LOD = 0.5 pg/mg albumin). Unadjusted GM AFB1-lys (pg/mg albumin) was 1.33 (95% CI: 1.21-1.47). Serum AFB1-lys was higher in males (GM: 1.57; 95% CI: 1.38-1.80) vs. females (GM: 1.12; 95% CI: 0.97-1.30) (P = .0019), and higher in persons residing in urban settings (GM: 2.83; 95% CI: 2.37-3.37) vs. rural (GM: 1.10; 95% CI: 0.99-1.23) (P < .0001). When we used a multivariable censored regression model to assess confounding and interactions among variables we found that survey region, gender, age, occupation, distance to marketplace, and number of meals per day were statistically significant predictors of aflatoxin exposure. While not nationally representative, our findings provide an improved understanding of the widespread burden of aflatoxin exposure throughout Uganda and identify key geographic, demographic, and socioeconomic factors that may modulate aflatoxin exposure risk.
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Affiliation(s)
- Nicholas C Zitomer
- Centers for Disease Control and Prevention (CDC), National Center for Environmental Health (NCEH) , Division of Laboratory Sciences (DLS), Atlanta, Georgia
| | - Abigael O Awuor
- CDC-Kenya, Center for Global Health (CGH) , Division of Global Health Protection, Nairobi, Kenya
| | - Marc-Alain Widdowson
- CDC-Kenya, Center for Global Health (CGH) , Division of Global Health Protection, Nairobi, Kenya.,Institute of Tropical Medicine , Antwerp, Belgium
| | - Johnni H Daniel
- CDC, NCEH, Division of Environmental Health Hazards & Health Effects , Atlanta, Georgia
| | - Maya R Sternberg
- Centers for Disease Control and Prevention (CDC), National Center for Environmental Health (NCEH) , Division of Laboratory Sciences (DLS), Atlanta, Georgia
| | - Michael E Rybak
- Centers for Disease Control and Prevention (CDC), National Center for Environmental Health (NCEH) , Division of Laboratory Sciences (DLS), Atlanta, Georgia
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18
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Wenndt A, Sudini HK, Pingali P, Nelson R. Exploring aflatoxin contamination and household-level exposure risk in diverse Indian food systems. PLoS One 2020; 15:e0240565. [PMID: 33104713 PMCID: PMC7588076 DOI: 10.1371/journal.pone.0240565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/29/2020] [Indexed: 11/19/2022] Open
Abstract
The present study sought to identify household risk factors associated with aflatoxin contamination within and across diverse Indian food systems and to evaluate their utility in risk modeling. Samples (n = 595) of cereals, pulses, and oil seeds were collected from 160 households across four diverse districts of India and analyzed for aflatoxin B1 using enzyme-linked immunosorbent assay (ELISA). Demographic information, food and cropping systems, food management behaviors, and storage environments were profiled for each household. An aflatoxin detection risk index was developed based on household-level features and validated using a repeated 5-fold cross-validation approach. Across districts, between 30–80% of households yielded at least one contaminated sample. Aflatoxin B1 detection rates and mean contamination levels were highest in groundnut and maize, respectively, and lower in other crops. Landholding had a positive univariate effect on household aflatoxin detection, while storage conditions, product source, and the number of protective behaviors used by households did not show significant effects. Presence of groundnut, post-harvest grain washing, use of sack-based storage systems, and cultivation status (farming or non-farming) were identified as the most contributive variables in stepwise logistic regression and were used to generate a household-level risk index. The index had moderate classification accuracy (68% sensitivity and 62% specificity) and significantly correlated with village-wise aflatoxin detection rates. Spatial analysis revealed utility of the index for identifying at-risk localities and households. This study identified several key features associated with aflatoxin contamination in Indian food systems and demonstrated that household characteristics are substantially predictive of aflatoxin risk.
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Affiliation(s)
- Anthony Wenndt
- Plant Pathology and Plant-Microbe Biology, School of Integrative Plant Sciences, Cornell University, Ithaca, New York, United States of America
- Tata Cornell Institute for Agriculture and Nutrition, Cornell University, Ithaca, New York, United States of America
- * E-mail:
| | - Hari Kishan Sudini
- International Crops Research Institute for the Semi-Arid Tropics, Patancheru, Telangana, India
| | - Prabhu Pingali
- Tata Cornell Institute for Agriculture and Nutrition, Cornell University, Ithaca, New York, United States of America
- Charles H. Dyson School of Applied Economics & Management, Cornell University, Ithaca, New York, United States of America
| | - Rebecca Nelson
- Plant Pathology and Plant-Microbe Biology, School of Integrative Plant Sciences, Cornell University, Ithaca, New York, United States of America
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Díaz de León-Martínez L, Rodríguez-Aguilar M, Wong-Arce A, Díaz-Barriga F, Bañuelos-Hernández B, Rosales-Mendoza S, Flores-Ramírez R. Evaluation of acute and chronic exposure to aflatoxin B 1 in indigenous women of the Huasteca Potosina, Mexico. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:30583-30591. [PMID: 32468362 DOI: 10.1007/s11356-020-09361-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/18/2020] [Indexed: 06/11/2023]
Abstract
Aflatoxin B1 (AFB1) is one of the most studied mycotoxins due to its high occurrence in food and its hepatotoxic, immunosuppressive, carcinogenic, childhood growth, genotoxic, mutagenic, and teratogenic effects in humans and animals. Exposure to AFB1 is reported to be both, acute and chronic; the main exposure pathway to AFB1 is through the intake of contaminated food. In Mexico, although the reports of several studies addressing the problem of aflatoxins in maize and other foods, the evidence has been centered on exposure to AFB1 and to the quantification of the Aflatoxins themselves, but there is null evidence about genotoxic effects of aflatoxins in vulnerable populations. Therefore, this study focused on assessing chronic AFB1 exposure through the AFB1-lys biomarker adduct and acute exposure through total AFB1-DNA adducts in women from a rural indigenous community in the Huasteca Potosina (Mexico). A hundred percent of the studied population presented total AFB1-DNA and AFB1-lys adducts in concentrations of 1.08 (0.48-1.34) μmol of adduct/mol of DNA and 2.33 (1.08-102.6) pg/mg of albumin respectively (median (min-max)). Thus, continuous monitoring and important changes in regulations are desired and recommended. The results in this study provide enough evidence to support the toxic effects that the exposure to AFB1 represents, as well as the population risk that it poses, and in the same sense, the current need to create an intervention program that directly influences the control of the sources of exposure in order to reduce it.
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Affiliation(s)
- Lorena Díaz de León-Martínez
- Centro de Investigación Aplicada en Ambiente y Salud, CIACYT, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, Av. Venustiano Carranza 2405, 78210, San Luis Potosí, SLP, México
| | - Maribel Rodríguez-Aguilar
- Centro de Investigación Aplicada en Ambiente y Salud, CIACYT, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, Av. Venustiano Carranza 2405, 78210, San Luis Potosí, SLP, México
| | - Alejandra Wong-Arce
- Sección de Biotecnología, Centro de Investigación en Ciencias de la Salud y Biomedicina, Universidad Autónoma de San Luis Potosí, Avenue Sierra Leona 550, Lomas 2ª. Sección, 78210, San Luis Potosí, Mexico
| | - Fernando Díaz-Barriga
- Centro de Investigación Aplicada en Ambiente y Salud, CIACYT, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, Av. Venustiano Carranza 2405, 78210, San Luis Potosí, SLP, México
| | - Bernardo Bañuelos-Hernández
- Escuela de Veterinaria, Universidad De La Salle Bajío, Avenida Universidad No. 302, Colonia Lomas del Campestre, 37150, León, GTO, México
| | - Sergio Rosales-Mendoza
- Sección de Biotecnología, Centro de Investigación en Ciencias de la Salud y Biomedicina, Universidad Autónoma de San Luis Potosí, Avenue Sierra Leona 550, Lomas 2ª. Sección, 78210, San Luis Potosí, Mexico
| | - Rogelio Flores-Ramírez
- CONACYT Research Fellow, Coordinación para la Innovación y Aplicación de la Ciencia y la Tecnología (CIACYT), Universidad Autónoma de San Luis Potosí, Avenida Sierra Leona No. 550, Colonia Lomas Segunda Sección, 78210, San Luis Potosí, SLP, México.
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Rodríguez-Aguilar M, Solís-Mercado J, Flores-Ramírez R, Díaz-Barriga F, Zuki-Orozco A, Cilia-López V. Aflatoxins and the traditional process of nixtamalisation in indigenous communities from the Huasteca Potosina region. WORLD MYCOTOXIN J 2020. [DOI: 10.3920/wmj2019.2538] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Aflatoxins represent one of the biggest public health problems in food safety, due to their toxic potential for humans and animals. They can lead to serious threats, such as hepatotoxicity, teratogenicity and immunotoxicity. Maize is the most important cereal consumed in Mexico, with which tortillas, tamales, flours, toasts and other products are elaborated. The elaboration of tortillas begins with nixtamalisation, which is an ancient maize process, developed and applied by indigenous Mesoamerican population. Some studies have shown the effect of nixtamalisation in the inactivation of aflatoxins. The purpose of this research was to record the traditional nixtamalisation process (TNP) and to register the presence of the aflatoxin B1 (AFB1) in tortillas and the exposure to AFB1 in indigenous communities living in the Huasteca Potosina, in central México. To register the nixtamalisation technique, a questionnaire was given to women, to illustrate the process step by step. Digestion, extraction, purification, and identification of the adduct AFB1-lysine (AFB1-Lys) in serum were performed. The TNP was analysed by 51 surveys, 4% of the tortillas was above the maximum permissible levels, according to Mexican guidelines; however, all blood samples showed presence of AFB1. TNP done in indigenous communities in the Huasteca Potosina region is not efficient enough to eliminate aflatoxins present in contaminated maize. It is necessary to improve conditions of places in which the grain is stored and knowledge about the risk of exposure to aflatoxins in rural communities, as key steps for preventing exposure to this type of mycotoxins.
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Affiliation(s)
- M. Rodríguez-Aguilar
- Centro de Investigación Aplicada en Ambiente y Salud, CIACYT, Facultad de Medicina, Universidad Autónoma de San Luis Potosí. Av. Venustiano Carranza 2405, CP 78210, San Luis Potosí, México
| | - J. Solís-Mercado
- Centro de Investigación Aplicada en Ambiente y Salud, CIACYT, Facultad de Medicina, Universidad Autónoma de San Luis Potosí. Av. Venustiano Carranza 2405, CP 78210, San Luis Potosí, México
| | - R. Flores-Ramírez
- CONACYT, Coordinación para la Innovación y Aplicación de la Ciencia y la Tecnología (CIACYT), Universidad Autónoma de San Luis Potosí, Avenida Sierra Leona No. 550, CP 78210, Colonia Lomas Segunda Sección, San Luis Potosí, México
| | - F. Díaz-Barriga
- Centro de Investigación Aplicada en Ambiente y Salud, CIACYT, Facultad de Medicina, Universidad Autónoma de San Luis Potosí. Av. Venustiano Carranza 2405, CP 78210, San Luis Potosí, México
| | - A. Zuki-Orozco
- Centro de Investigación Aplicada en Ambiente y Salud, CIACYT, Facultad de Medicina, Universidad Autónoma de San Luis Potosí. Av. Venustiano Carranza 2405, CP 78210, San Luis Potosí, México
| | - V.G. Cilia-López
- Centro de Investigación Aplicada en Ambiente y Salud, CIACYT, Facultad de Medicina, Universidad Autónoma de San Luis Potosí. Av. Venustiano Carranza 2405, CP 78210, San Luis Potosí, México
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21
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Yin J, Fan W, Du J, Feng W, Dong Z, Liu Y, Zhou T. The toxicity of graphene oxide affected by algal physiological characteristics: A comparative study in cyanobacterial, green algae, diatom. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 248:865-873. [PMID: 32000020 DOI: 10.1016/j.envpol.2019.02.091] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 02/14/2019] [Accepted: 02/25/2019] [Indexed: 05/07/2023]
Abstract
Though the main toxic mechanisms of graphene oxide (GO) to algae have been accepted as the shading effect, oxidative stress and mechanical damage, the effect of algal characteristics on these three mechanisms of GO toxicity have seldom been taken into consideration. In this study, we investigated GO toxicity to green algae (Chlorella vulgaris, Scenedesmus obliquus, Chlamydomonas reinhardtii), cyanobacteria (Microcystis aeruginosa) and diatoms (Cyclotella sp.). The aim was to assess how the physiological characteristics of algae affect the toxicity of GO. Results showed that 10 mg/L of GO significantly inhibited the growth of all tested algal types, while S. obliquus and C. reinhardtii were found to be the most susceptible and tolerant species, respectively. Then, scanning electron microscopy (SEM) and transmission electron microscopy (TEM) were used to observe the physiological characteristics of the assessed algae. The presence of locomotive organelles, along with smaller and more spherical cells, was more likely to alleviate the shading effect. Variations in cell wall composition led to different extents of mechanical damage as shown by Cyclotella sp. silica frustules and S. obliquus autosporine division being prone to damage. Meanwhile, growth inhibition and cell division were significantly correlated with the oxidative stress and membrane permeability, suggesting the latter two indicators can effectively signal GO toxicity to algae. The findings of this study provide novel insights into the toxicity of graphene materials in aquatic environments.
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Affiliation(s)
- Jingyu Yin
- School of Space and Environment, Beihang University, No. 37, XueYuan Road, HaiDian District, Beijing 100191, PR China
| | - Wenhong Fan
- School of Space and Environment, Beihang University, No. 37, XueYuan Road, HaiDian District, Beijing 100191, PR China; Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing 100191, PR China.
| | - Juan Du
- School of Space and Environment, Beihang University, No. 37, XueYuan Road, HaiDian District, Beijing 100191, PR China
| | - Weiying Feng
- School of Space and Environment, Beihang University, No. 37, XueYuan Road, HaiDian District, Beijing 100191, PR China
| | - Zhaomin Dong
- School of Space and Environment, Beihang University, No. 37, XueYuan Road, HaiDian District, Beijing 100191, PR China
| | - Yingying Liu
- School of Space and Environment, Beihang University, No. 37, XueYuan Road, HaiDian District, Beijing 100191, PR China
| | - Tingting Zhou
- School of Space and Environment, Beihang University, No. 37, XueYuan Road, HaiDian District, Beijing 100191, PR China
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Karayağiz Muslu G, Özdemir M. Occurrence of and Factors Associated With the Presence of Aflatoxin M 1 in Breast Milk of Mothers in Fethiye, Turkey. Biol Res Nurs 2020; 22:362-368. [PMID: 32314592 DOI: 10.1177/1099800420919900] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Gonca Karayağiz Muslu
- Department of Nursing, Fethiye Faculty of Health Sciences, Muğla Sıtkı Koçman University, Turkey
| | - Mehmet Özdemir
- Department of Medical Pharmacology, Faculty of Medicine, Karabük University, Turkey
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Passarelli S, Bromage S, Darling AM, Wang J, Aboud S, Mugusi F, Griffiths JK, Fawzi W. Aflatoxin exposure in utero and birth and growth outcomes in Tanzania. MATERNAL & CHILD NUTRITION 2020; 16:e12917. [PMID: 31823516 PMCID: PMC7083471 DOI: 10.1111/mcn.12917] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 10/03/2019] [Accepted: 10/31/2019] [Indexed: 01/09/2023]
Abstract
Some evidence suggests that aflatoxin may contribute to the high prevalence of stunting observed in low-income countries. Whereas several studies have been conducted in West Africa, fewer exist in East Africa and even fewer in nonagricultural contexts. We analyzed serum samples from 400 iron-replete, nonanemic pregnant women from a cohort in Dar es Salaam, Tanzania to determine the extent and magnitude of exposure to aflatoxin and to study the relationship between levels of aflatoxin exposure in utero and infant birth and growth outcomes. Ninety-nine percent of women had detectable concentrations of aflatoxin B1-lysine (AFB1-lysine), with a median level of 1.4-pg/mg albumin, indicating a much lower level compared to studies of rural populations in sub-Saharan Africa. Our results do not show a statistically significant relationship between AFB1-lysine levels and birth weight, small for gestational age, or prematurity. We observe a small statistically significant reduction in gestational age at delivery (0.47 weeks; 95% CI: -0.86, -0.07) as the natural log of AFB1-lysine levels increases by 1 unit of pg/mg of albumin, after controlling for potential confounders. Among a nonrandom set of infants who had measurements for placental weight, haemoglobin at delivery, and follow-up z-score measurements, we find no association between aflatoxin plasma concentrations and these variables. These findings suggest a high prevalence of chronic low-level exposure to aflatoxin, though its effect on birth outcomes in this population remains unclear. Our research adds to a growing body of literature finding mixed associations between aflatoxins on pregnancy outcomes and child growth.
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Affiliation(s)
- Simone Passarelli
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMassachusetts
| | - Sabri Bromage
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMassachusetts
| | - Anne Marie Darling
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMassachusetts
| | - Jia‐Sheng Wang
- Department of Environmental Health ScienceUniversity of GeorgiaAthensGeorgia
| | - Said Aboud
- Department of Microbiology and ImmunologyMuhimbili University of Health and Allied SciencesSalaamTanzania
| | - Ferdinand Mugusi
- Department of Internal MedicineMuhimbili University of Health and Allied SciencesSalaamTanzania
| | - Jeffrey K. Griffiths
- Department of Public Health and Community MedicineTufts University School of MedicineBostonMassachusetts
| | - Wafaie Fawzi
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMassachusetts
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMassachusetts
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusetts
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Arce-López B, Lizarraga E, Vettorazzi A, González-Peñas E. Human Biomonitoring of Mycotoxins in Blood, Plasma and Serum in Recent Years: A Review. Toxins (Basel) 2020; 12:E147. [PMID: 32121036 PMCID: PMC7150965 DOI: 10.3390/toxins12030147] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/14/2020] [Accepted: 02/25/2020] [Indexed: 12/17/2022] Open
Abstract
This manuscript reviews the state-of-the-art regarding human biological monitoring (HBM) of mycotoxins in plasma serum and blood samples. After a comprehensive and systematic literature review, with a focus on the last five years, several aspects were analyzed and summarized: a) the biomarkers analyzed and their encountered levels, b) the analytical methodologies developed and c) the relationship between biomarker levels and some illnesses. In the literature reviewed, aflatoxin B1-lysine (AFB1-lys) and ochratoxin A (OTA) in plasma and serum were the most widely studied mycotoxin biomarkers for HBM. Regarding analytical methodologies, a clear increase in the development of methods for the simultaneous determination of multiple mycotoxins has been observed. For this purpose, the use of liquid chromatography (LC) methodologies, especially when coupled with tandem mass spectrometry (MS/MS) or high resolution mass spectrometry (HRMS), has grown. A high percentage of the samples analyzed for OTA or aflatoxin B1 (mostly as AFB1-lys) in the reviewed papers were positive, demonstrating human exposure to mycotoxins. This review confirms the importance of mycotoxin human biomonitoring and highlights the important challenges that should be faced, such as the inclusion of other mycotoxins in HBM programs, the need to increase knowledge of mycotoxin metabolism and toxicokinetics, and the need for reference materials and new methodologies for treating samples. In addition, guidelines are required for analytical method validation, as well as equations to establish the relationship between human fluid levels and mycotoxin intake.
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Affiliation(s)
- Beatriz Arce-López
- Department of Pharmaceutical Technology and Chemistry; Universidad de Navarra, 31008 Pamplona, Navarra, Spain; (B.A.-L.); (E.G.-P.)
| | - Elena Lizarraga
- Department of Pharmaceutical Technology and Chemistry; Universidad de Navarra, 31008 Pamplona, Navarra, Spain; (B.A.-L.); (E.G.-P.)
| | - Ariane Vettorazzi
- Department of Pharmacology and Toxicology. School of Pharmacy and Nutrition, 31008 Pamplona, Navarra, Spain;
- IdiSNA, Institute for Health Research, 31008 Pamplona, Navarra, Spain
| | - Elena González-Peñas
- Department of Pharmaceutical Technology and Chemistry; Universidad de Navarra, 31008 Pamplona, Navarra, Spain; (B.A.-L.); (E.G.-P.)
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de León-Martínez LD, Solis-Mercado J, Rodríguez-Aguilar M, Díaz-Barriga F, Ortíz DG, Flores-Ramírez R. Assessment of aflatoxin B1-lysine adduct in serum of infant population of the Huasteca Potosina, México – a pilot study. WORLD MYCOTOXIN J 2019. [DOI: 10.3920/wmj2019.2457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Aflatoxins are mycotoxins considered to be highly toxic and produce adverse effects on human health. These compounds, mainly aflatoxin B1 (AFB1), have been classified as human carcinogens, due to its association with the development of hepatocellular carcinoma. In Mexico, the study of aflatoxins has been focused on the evaluation of products of the basic basket, particularly on maize, which is the basis of the Mexican diet. On the other hand, most of these studies have been conducted in urban areas. Indigenous populations may be exposed to a higher risk than urban ones due to the high consumption of tortillas, the harvest and the storage conditions of their food; hence, AFB1 is frequently found contaminating maize, which is the main food source for Mexicans. There is scarce evidence of exposure in vulnerable populations, such as children. Therefore, the main objective of this research was to conduct a pilot study for the evaluation of exposure to AFB1 through the AFB1-lys adduct in 31 serum samples of children from indigenous communities in Mexico. AFB1-lys was measured by High Pressure Liquid Chromatography with fluorescence detector (HPLC-FLD), with limits of detection and quantification of 3.5 and 4.7 pg/ml, respectively. Results from this pilot study revealed that 13% of children were of short stature, 9.7% presented overweight and 6.5% obesity. 45% of the children presented detectable concentrations of AFB1-lys adduct, with a median (minimum-maximum) of 5.6 (4.8-6.5) pg of AFB1-lys adduct/mg of albumin. The AFB1-lysine exposure biomarker is an important tool for the surveillance of aflatoxins and their effects on health, so, following this intervention, it would be necessary to monitor the exposure of vulnerable populations to aflatoxins, especially in rural areas where foods are more contaminated.
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Affiliation(s)
- L. Díaz de León-Martínez
- Centro de Investigación Aplicada en Ambiente y Salud, CIACYT, Facultad de Medicina, Universidad Autónoma de San Luis Potosí. Av. Venustiano Carranza 2405, CP 78210, San Luis Potosí, México
| | - J. Solis-Mercado
- Centro de Investigación Aplicada en Ambiente y Salud, CIACYT, Facultad de Medicina, Universidad Autónoma de San Luis Potosí. Av. Venustiano Carranza 2405, CP 78210, San Luis Potosí, México
| | - M. Rodríguez-Aguilar
- Centro de Investigación Aplicada en Ambiente y Salud, CIACYT, Facultad de Medicina, Universidad Autónoma de San Luis Potosí. Av. Venustiano Carranza 2405, CP 78210, San Luis Potosí, México
| | - F. Díaz-Barriga
- Centro de Investigación Aplicada en Ambiente y Salud, CIACYT, Facultad de Medicina, Universidad Autónoma de San Luis Potosí. Av. Venustiano Carranza 2405, CP 78210, San Luis Potosí, México
| | - D. Guzmán Ortíz
- Departamento de Biotecnología y Bioquímica Centro de Investigación de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Campus Guanajuato, Irapuato, México
| | - R. Flores-Ramírez
- CONACYT Research Fellow, Coordinación para la Innovación y Aplicación de la Ciencia y la Tecnología (CIACYT), Universidad Autónoma de San Luis Potosí, Avenida Sierra Leona No. 550, CP 78210, Colonia Lomas Segunda Sección, San Luis Potosí, México
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Andrews-Trevino JY, Webb P, Shively G, Rogers BL, Baral K, Davis D, Paudel K, Pokharel A, Shrestha R, Wang JS, Ghosh S. Relatively Low Maternal Aflatoxin Exposure Is Associated with Small-for-Gestational-Age but Not with Other Birth Outcomes in a Prospective Birth Cohort Study of Nepalese Infants. J Nutr 2019; 149:1818-1825. [PMID: 31198947 DOI: 10.1093/jn/nxz122] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Exposure to aflatoxin has garnered increased attention as a possible contributor to adverse birth outcomes. OBJECTIVE The objective of this study was to investigate the relation of maternal aflatoxin exposure with adverse birth outcomes such as birth weight, birth length, anthropometric z scores, low birth weight (LBW), small-for-gestational-age (SGA), stunting, and preterm birth (PTB). METHODS This study used maternal and newborn data from the AflaCohort Study, an ongoing birth cohort study in Banke, Nepal (n = 1621). Data on aflatoxin B1 (AFB1)-lysine adducts in maternal serum were collected once during pregnancy (at mean ± SD: 136 ± 43 d of gestation). Maternal serum AFB1-lysine adduct concentration was measured via HPLC. Linear and logistic regression analyses were used to determine if maternal aflatoxin exposure was associated with 1) birth weight and length (primary outcomes) and 2) anthropometric z scores, LBW (weight <2.5 kg), SGA (weight <10th percentile for gestational age and sex), stunting at birth (length-for-age z score less than -2), or PTB (born <37 weeks of gestation) (secondary outcomes). RESULTS The geometric mean of maternal serum AFB1-lysine adduct concentration was 1.37 pg/mg albumin (95% CI: 1.30, 1.44 pg/mg albumin). Twenty percent of infants were of LBW and 32% were SGA. Sixteen percent of infants were stunted at birth. In addition, 13% of infants were born preterm. In logistic multivariate regression models, mean maternal serum AFB1-lysine adduct concentrations were significantly associated with SGA (OR: 1.13; 95% CI: 1.00, 1.27; P < 0.05). CONCLUSIONS Findings from this study suggest a small but significant association between serum AFB1-lysine adduct concentrations in pregnant women and SGA. Maternal aflatoxin exposure was not associated with other birth outcomes. These results highlight the need for future research on a threshold level of aflatoxin exposure needed to produce detectable adverse birth outcomes. This trial was registered at clinicaltrials.gov as NCT03312049.
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Affiliation(s)
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Gerald Shively
- Department of Agricultural Economics, Purdue University, West Lafayette, IN, USA
| | - Beatrice L Rogers
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Kedar Baral
- Department of Community Health Sciences, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Dale Davis
- Helen Keller International-Nepal, Kathmandu, Nepal
| | | | | | - Robin Shrestha
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Jia-Sheng Wang
- Department of Environmental Health Science, University of Georgia, Athens, GA, USA
| | - Shibani Ghosh
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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27
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de Almeida L, Williams R, Soares DM, Nesbitt H, Wright G, Erskine W. Aflatoxin levels in maize and peanut and blood in women and children: The case of Timor-Leste. Sci Rep 2019; 9:13158. [PMID: 31511633 PMCID: PMC6739342 DOI: 10.1038/s41598-019-49584-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 08/27/2019] [Indexed: 11/09/2022] Open
Abstract
Aflatoxins are toxic fungal metabolites produced by Aspergillus sp. with carcinogenic properties that are a common food contaminant of many crops including maize and peanuts. In Timor-Leste malnutrition and children's stunting are frequent and maize and peanuts are staple foods. This study aimed to provide information on aflatoxin exposure nationally. The study measured levels of aflatoxin in locally-produced maize and peanuts (296 samples) and of aflatoxin-albumin conjugate in blood samples of women and young children (514 and 620 respectively) across all municipalities. The average concentration of aflatoxin in the grain samples was low with most maize (88%) and peanut (92%) samples - lower than European Commission tolerated aflatoxin level. Although aflatoxin-albumin conjugate was detected in more than 80% of blood samples, the average concentration in children and adults of 0.64 and 0.98 pg mg-1 alb, respectively, is much lower than in other similar rural-based countries. Although low in concentration, blood aflatoxin levels and aflatoxin contamination levels in maize across municipalities were correlated significantly for mothers (R2 = 37%, n = 495) but not for children (R2 = 10%). It is unlikely that the consumption of aflatoxin contaminated grain is a causative factor in the current level of malnutrition and stunting affecting Timor-Leste children.
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Affiliation(s)
- Luis de Almeida
- AI-Com, Ministry of Agriculture and Fisheries, PO Box 221, Comoro-Dili, Timor-Leste.,Centre for Plant Genetics and Breeding, UWA School of Agriculture and Environment & Institute of Agriculture, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - Robert Williams
- AI-Com, Ministry of Agriculture and Fisheries, PO Box 221, Comoro-Dili, Timor-Leste.,Centre for Plant Genetics and Breeding, UWA School of Agriculture and Environment & Institute of Agriculture, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | | | - Harry Nesbitt
- Centre for Plant Genetics and Breeding, UWA School of Agriculture and Environment & Institute of Agriculture, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - Graeme Wright
- Peanut Company of Australia (PCA), 133 Haly Street, Kingaroy, Qld, 4610, Australia
| | - William Erskine
- Centre for Plant Genetics and Breeding, UWA School of Agriculture and Environment & Institute of Agriculture, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
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Zhang J, Orang’o O, Tonui P, Tong Y, Maina T, Kiptoo S, Muthoka K, Groopman J, Smith J, Madeen E, Ermel A, Loehrer P, Brown DR. Detection and Concentration of Plasma Aflatoxin is Associated with Detection of Oncogenic Human Papillomavirus in Kenyan Women. Open Forum Infect Dis 2019; 6:ofz354. [PMID: 31392332 PMCID: PMC6736060 DOI: 10.1093/ofid/ofz354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/05/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Cervical cancer is common in Kenyan women. Cofactors in addition to infection with oncogenic human papillomavirus (HPV) are likely to be important in causing cervical cancer, as only a small percentage of HPV-infected women will develop this malignancy. Kenyan women are exposed to dietary aflatoxin, a potent carcinogen and immunosuppressive agent, which may be such a co-factor. METHODS Demographics, behavioral data, plasma, and cervical swabs were collected from 88 HIV-uninfected Kenyan women without cervical dysplasia. HPV detection was compared between women with or without plasma AFB1-lys and evaluated in relation to AFB1-lys concentration. RESULTS Valid HPV testing results were available for 86 women (mean age 34.0 years); 49 women (57.0%) had AFB1-lys detected and 37 (43.0%) had none. AFB1-lys detection was not associated with age, being married, having more than secondary school education, home ownership, living at a walking distance to health care ≥60 minutes, number of lifetime sex partners, or age of first sex. AFB1-lys detection and plasma concentrations were associated with detection of oncogenic HPV types. CONCLUSIONS AFB1-lys-positivity and higher plasma AFB1-lys concentrations were associated with higher risk of oncogenic HPV detection in cervical samples from Kenya women. Further studies are needed to determine if aflatoxin interacts with HPV in a synergistic manner to increase the risk of cervical cancer.
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Affiliation(s)
- Jianjun Zhang
- Department of Epidemiology, Fairbanks School of Public Health, Indiana University, Indianapolis
| | - Omenge Orang’o
- Department of Reproductive Health, Moi University, Eldoret, Kenya
| | - Philip Tonui
- Department of Reproductive Health, Moi University, Eldoret, Kenya
| | - Yan Tong
- Department of Biostatistics, Indiana University School of Medicine and Fairbanks School of Public Health, Indianapolis
| | - Titus Maina
- Department of Molecular Biology, Maseno University, Kenya
| | - Stephen Kiptoo
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Katpen Muthoka
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - John Groopman
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Departments of
| | - Joshua Smith
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Departments of
| | - Erin Madeen
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Departments of
| | | | | | - Darron R Brown
- Medicine, Indianapolis
- Microbiology and Immunology, Indiana University School of Medicine, Indianapolis
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Aflatoxin Binders in Foods for Human Consumption-Can This be Promoted Safely and Ethically? Toxins (Basel) 2019; 11:toxins11070410. [PMID: 31337106 PMCID: PMC6669551 DOI: 10.3390/toxins11070410] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 07/06/2019] [Accepted: 07/12/2019] [Indexed: 12/20/2022] Open
Abstract
Aflatoxins continue to be a food safety problem globally, especially in developing regions. A significant amount of effort and resources have been invested in an attempt to control aflatoxins. However, these efforts have not substantially decreased the prevalence nor the dietary exposure to aflatoxins in developing countries. One approach to aflatoxin control is the use of binding agents in foods, and lactic acid bacteria (LAB) have been studied extensively for this purpose. However, when assessing the results comprehensively and reviewing the practicality and ethics of use, risks are evident, and concerns arise. In conclusion, our review suggests that there are too many issues with using LAB for aflatoxin binding for it to be safely promoted. Arguably, using binders in human food might even worsen food safety in the longer term.
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Al-Jaal BA, Jaganjac M, Barcaru A, Horvatovich P, Latiff A. Aflatoxin, fumonisin, ochratoxin, zearalenone and deoxynivalenol biomarkers in human biological fluids: A systematic literature review, 2001–2018. Food Chem Toxicol 2019; 129:211-228. [DOI: 10.1016/j.fct.2019.04.047] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/11/2019] [Accepted: 04/25/2019] [Indexed: 01/25/2023]
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Enhancing Food Safety through Adoption of Long-Term Technical Advisory, Financial, and Storage Support Services in Maize Growing Areas of East Africa. SUSTAINABILITY 2019. [DOI: 10.3390/su11102827] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Grain production and storage are major components in food security. In the ancient times, food security was achieved through gathering of fruits, grains, herbs, tubers, and roots from the forests by individual households. Advancements in human civilization led to domestication of crops and a need to save food for not only a household, but the nation. This extended need for food security led to establishment of national reservoirs for major produces and this practice varies greatly in different states. Each of the applied food production, handling, and storage approaches has its benefits and challenges. In sub-Saharan Africa, several countries have a public funded budget to subsidize production costs, to buy grains from farmers, and to store the produce for a specific period and/or until the next harvests. During the times of famine, the stored grains are later sold at subsidized prices or are given for free to the starving citizens. If there is no famine, the grain is sold to retailers and/or processors (e.g., millers) who later sell it to the consumers. This approach works well if the produce (mainly grain) is stored under conditions that do not favor growth of molds, as some of these microbes could contaminate the grain with toxic and carcinogenic metabolites called mycotoxins. Conditions that alleviate contamination of grains are required during production, handling, and storage. Most of the grain is produced by smallholder farmers under sub-optimal conditions, making it vulnerable to colonization and contamination by toxigenic fungi. Further, the grain is stored in silos at large masses, where it is hard to monitor the conditions at different points of these facilities, and hence, it becomes vulnerable to additional contamination. Production and storage of grain under conditions that favor mycotoxins poses major food health and safety risks to humans and livestock who consume it. This concept paper focuses on how establishment of a local grain production and banking system (LGPBS) could enhance food security and safety in East Africa. The concept of LGPBS provides an extension of advisory and finance support within warehouse receipt system to enhance grain production under optimal conditions. The major practices at the LGPBS and how each could contribute to food security and safety are discussed. While the concept paper gives more strength on maize production and safety, similar practices could be applied to enhance safety of other grains in the same LGPBS.
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Githang'a D, Wangia RN, Mureithi MW, Wandiga SO, Mutegi C, Ogutu B, Agweyu A, Wang JS, Anzala O. The effects of aflatoxin exposure on Hepatitis B-vaccine induced immunity in Kenyan children. Curr Probl Pediatr Adolesc Health Care 2019; 49:117-130. [PMID: 31103452 PMCID: PMC7116700 DOI: 10.1016/j.cppeds.2019.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Globally, approximately three million children die each year from vaccine preventable infectious diseases mainly in developing countries. Despite the success of the expanded immunization program, not all infants and children around the world develop the same protective immune response to the same vaccine. A vaccine must induce a response over the basal immune response that may be driven by population-specific, environmental or socio-economic factors. Mycotoxins like aflatoxins are immune suppressants that are confirmed to interfere with both cell-mediated and acquired immunity. The mechanism of aflatoxin toxicity is through the binding of the bio-activated AFB1-8, 9-epoxide to cellular macromolecules. METHODS We studied Hepatitis B surface antibodies [anti-HBs] levels to explore the immune modulation effects of dietary exposure to aflatoxins in children aged between one and fourteen years in Kenya. Hepatitis B vaccine was introduced for routine administration for Kenyan infants in November 2001. To assess the effects of aflatoxin on immunogenicity of childhood vaccines Aflatoxin B1-lysine in blood serum samples were determined using High Performance Liquid Chromatography with Fluorescence detection while anti-HBs were measured using Bio-ELISA anti-HBs kit. RESULTS The mean ± SD of AFB1-lysine adducts in our study population was 45.38 ± 87.03 pg/mg of albumin while the geometric mean was 20.40 pg/mg. The distribution of AFB1-lysine adducts was skewed to the right. Only 98/205 (47.8%) of the study population tested positive for Hepatitis B surface antibodies. From regression analysis, we noted that for every unit rise in serum aflatoxin level, anti-HBs dropped by 0.91 mIU/ml (-0.9110038; 95% C.I -1.604948, -0.21706). CONCLUSION Despite high coverage of routine immunization, less than half of the study population had developed immunity to HepB. Exposure to aflatoxin was high and weakly associated with low anti-HBs antibodies. These findings highlight a potentially significant role for environmental factors that may contribute to vaccine effectiveness warranting further research.
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Affiliation(s)
- D Githang'a
- KAVI - Institute of Clinical Research, University of Nairobi, Kenya; Department of Medical Microbiology, School of Medicine, College of Health Sciences, University of Nairobi, Kenya.
| | - R N Wangia
- Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, GA 30602, United States
| | - M W Mureithi
- KAVI - Institute of Clinical Research, University of Nairobi, Kenya; Department of Medical Microbiology, School of Medicine, College of Health Sciences, University of Nairobi, Kenya
| | - S O Wandiga
- Department of Chemistry, College of Biological and Physical Sciences, University of Nairobi, Kenya
| | - C Mutegi
- International Institute of Tropical Agriculture [IITA], P.O BOX 30772-00100, Nigeria
| | - B Ogutu
- Centre for Clinical Research-Kenya Medical Research Institute, Kenya
| | - A Agweyu
- KEMRI-Wellcome Trust Research Programme, P.O. Box 43640 - 00100, Nairobi, Kenya
| | - J-S Wang
- Department of Environmental Health Science, College of Public Health, University of Georgia, Athens, GA 30602, United States
| | - O Anzala
- KAVI - Institute of Clinical Research, University of Nairobi, Kenya; Department of Medical Microbiology, School of Medicine, College of Health Sciences, University of Nairobi, Kenya
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Díaz de León-Martínez L, Díaz-Barriga F, Barbier O, Ortíz DLG, Ortega-Romero M, Pérez-Vázquez F, Flores-Ramírez R. Evaluation of emerging biomarkers of renal damage and exposure to aflatoxin-B 1 in Mexican indigenous women: a pilot study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:12205-12216. [PMID: 30835068 DOI: 10.1007/s11356-019-04634-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 02/19/2019] [Indexed: 05/18/2023]
Abstract
Aflatoxins (AFs) are mycotoxins produced by Aspergillus parasiticus and Aspergillus flavus which frequently contaminate maize. These compounds are considered toxic, especially AFB1 which has been classified as a human carcinogen, due to its relationship with the generation of hepatocellular carcinoma. Studies in vivo, in animal models, prove that chronic consumption of AFB1 has an association with renal adverse effects, but evidence in humans is scarce. Therefore, the main objective of this research was to conduct a pilot study to evaluate the correlation between exposure to AFB1 and early-stage renal damage in indigenous women of San Luis Potosí, Mexico. Exposure to AFB1 was measured through the biomarker AFB1-lysine and renal damage through kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), and cystatin-C (Cys-C). AFB1-Lys was measured by HPLC-FLD. The method was validated with a correlation coefficient of 0.99 and limit of detection and quantification of 3.5 and 4.7 pg mL-1, respectively. Levels of NGAL, KIM-1, and Cys-C were determined (median (P25-P75), 5.96 (3.16-15.91), 0.137 (0.137-0.281), and 18.49 (5.76-29.57) ng mL-1, respectively). Additionally, glomerular filtration rate (GFR) (83.3 (59.8-107.4) mL/min/1.73 m2) and serum creatinine (SCr) (0.88 (0.72-1.22) mg dL-1) were obtained. The median concentrations for AFB1-Lys were 2.08 (1.89-5.8) pg mg-1 of albumin. Statistically significant correlations between AFB1-Lys/KIM-1 (Rho = 0.498, p = 0.007) and AFB1/Cys-C (Rho = 0.431, p = 0.014) were found. Our results indicate that women are exposed to AFB1, due to the fact that the AFB1-Lys biomarker was found in a high percentage of the study population (83%). In addition, the results of exposure to AFB1 show a strong significant correlation between KIM-1 and Cys-C that may indicate the toxic renal effect. These results are alarming because of the high toxicity of this compound and require adequate intervention to reduce AFB1 exposure in these populations.
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Affiliation(s)
- Lorena Díaz de León-Martínez
- Centro de Investigación Aplicada en Ambiente y Salud (CIAAS), Avenida Sierra Leona No. 550, Colonia Lomas Segunda Sección, 78210, San Luis Potosí, SLP, Mexico
| | - Fernando Díaz-Barriga
- Centro de Investigación Aplicada en Ambiente y Salud (CIAAS), Avenida Sierra Leona No. 550, Colonia Lomas Segunda Sección, 78210, San Luis Potosí, SLP, Mexico
| | - Olivier Barbier
- Departamento de Toxicología, Centro de Investigación y de Estudios Avanzados-Instituto Politécnico Nacional (CINVESTAV-IPN), Mexico City, Mexico
| | - Dora Linda Guzmán Ortíz
- Departamento de Biotecnología y Bioquímica Centro de Investigación de Estudios Avanzados del -Instituto Politécnico Nacional (CINVESTAV-IPN), Campus Guanajuato, Irapuato, Mexico
| | - Manolo Ortega-Romero
- Departamento de Toxicología, Centro de Investigación y de Estudios Avanzados-Instituto Politécnico Nacional (CINVESTAV-IPN), Mexico City, Mexico
| | - Francisco Pérez-Vázquez
- Centro de Investigación Aplicada en Ambiente y Salud (CIAAS), Avenida Sierra Leona No. 550, Colonia Lomas Segunda Sección, 78210, San Luis Potosí, SLP, Mexico
| | - Rogelio Flores-Ramírez
- CONACYT Research Fellow, Coordinación para la Innovación y Aplicación de la Ciencia y la Tecnología (CIACYT), Avenida Sierra Leona No. 550, Colonia Lomas Segunda Sección, 78210, San Luis Potosí, SLP, Mexico.
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Chetwood JD, Garg P, Finch P, Gordon M. Systematic review: the etiology of esophageal squamous cell carcinoma in low-income settings. Expert Rev Gastroenterol Hepatol 2019; 13:71-88. [PMID: 30791842 DOI: 10.1080/17474124.2019.1543024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Esophageal carcinoma causes over 380 000 deaths per year, ranking sixth worldwide in mortality amongst all malignancies. Globally, the squamous cell subtype is most common and accounts for 80% of esophageal cancers. Nonetheless, esophageal squamous cell carcinoma is much more poorly understood than esophageal adenocarcinoma, including what is driving such high prevalences, why it often presents in young patients, and shows such marked geographical delineations Areas covered: The current literature was searched for articles focusing on aetiopathogenesis of squamous cell esophageal carcinoma via a systematic review, particularly in low-resource settings. This was supplemented by papers of interest known to the authors. Expert commentary: Current putative mechanisms include polycyclic aromatic hydrocarbons, nitrosamines, acetaldehyde, cyclo-oxygenase-2 pathways, androgen and their receptor levels, as well as smoking & alcohol, micronutrient deficiencies and diet, mycotoxins, thermal damage, oral hygiene and microbiotal factors, inhaled smoke, viral infections such as HPV, and chronic irritative states. Etiology is likely multifactorial and varies geographically. Though smoking and alcohol play a predominant role in high-income settings, there is strong evidence that mycotoxins, diet and temperature effects may play an under-recognized role in low and middle-income settings.
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Affiliation(s)
- John David Chetwood
- a Malawi Liverpool Wellcome Trust Clinical Research Programme , Blantyre , Malawi
| | - Priya Garg
- a Malawi Liverpool Wellcome Trust Clinical Research Programme , Blantyre , Malawi
| | | | - Melita Gordon
- a Malawi Liverpool Wellcome Trust Clinical Research Programme , Blantyre , Malawi.,b College of Medicine , Blantyre , Malawi.,c Institute of Infection and Global Health , University of Liverpool , Liverpool , UK
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Temesgen A, Teshome G. Major mycotoxins occurrence, prevention and control approaches. ACTA ACUST UNITED AC 2018. [DOI: 10.5897/bmbr2018.0274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Hoffmann V, Jones K, Leroy JL. The impact of reducing dietary aflatoxin exposure on child linear growth: a cluster randomised controlled trial in Kenya. BMJ Glob Health 2018; 3:e000983. [PMID: 30588341 PMCID: PMC6278920 DOI: 10.1136/bmjgh-2018-000983] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/29/2018] [Accepted: 10/14/2018] [Indexed: 01/10/2023] Open
Abstract
Introduction Observational studies have documented an association between aflatoxin (AF) exposure and reduced linear growth in infants and young children. Our objective was to assess the effectiveness of reducing AF exposure on child linear growth and serum AF levels in rural areas in Eastern Kenya. Methods A cluster randomised controlled design was used (28 intervention and 28 control clusters). The intervention arm received a swapping (contaminated maize was replaced with safe maize) and a stockist intervention (households were encouraged to purchase from a stockist supplied with clean maize). Women in the fifth to final month of pregnancy were invited to enrol in the study. Outcomes were child length-for-age Z-score (LAZ), the prevalence of stunting and child serum AFB1-lysine adduct level 24 (endline, primary outcomes) and 11 to 19 months (midline, secondary outcomes) after trial commencement, respectively. The trial was registered with socialscienceregistry.org. Results Of the 1230 unborn children enrolled in the study, 881 (72%) were included in the LAZ and 798 (65%) in the serum AFB1 analysis. The intervention significantly reduced endline ln serum AFB1-lysine adduct levels (intervention effect—0.273, 95% CI −0.547 to 0.001; one-sided p=0.025), but had no effect on endline LAZ or stunting (mean LAZ at endline was −1.64). At midline, the intervention increased LAZ by 0.16 (95% CI −0.009 to 0.33; one-sided p=0.032) and reduced stunting by seven percentage points (95% CI −0.125 to −0.007; one-sided p=0.015), but had no impact on serum AFB1 levels. Conclusion Improving access to AF-free maize substantially reduced endline serum AF, but had no effect on child linear growth. The midline analysis suggests that AF may affect linear growth at younger ages. Trial registration number AEARCTR-0000105.
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Affiliation(s)
- Vivian Hoffmann
- Markets, Trade and Institutions Division, International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | - Kelly Jones
- Economics Department, American University, Washington, DC, USA
| | - Jef L Leroy
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
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Watson S, Moore SE, Darboe MK, Chen G, Tu YK, Huang YT, Eriksen KG, Bernstein RM, Prentice AM, Wild CP, Xu Y, Routledge MN, Gong YY. Impaired growth in rural Gambian infants exposed to aflatoxin: a prospective cohort study. BMC Public Health 2018; 18:1247. [PMID: 30413157 PMCID: PMC6234772 DOI: 10.1186/s12889-018-6164-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 10/30/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Exposure to aflatoxin, a mycotoxin produced by fungi that commonly contaminates cereal crops across sub-Saharan Africa, has been associated with impaired child growth. We investigated the impact of aflatoxin exposure on the growth of Gambian infants from birth to two years of age, and the impact on insulin-like growth factor (IGF)-axis proteins. METHODS A subsample (N = 374) of infants from the Early Nutrition and Immune Development (ENID) trial (ISRCTN49285450) were included in this study. Aflatoxin-albumin adducts (AF-alb) were measured in blood collected from infants at 6, 12 and 18 months of age. IGF-1 and IGFBP-3 were measured in blood collected at 12 and 18 months. Anthropometric measurements taken at 6, 12, 18 and 24 months of age were converted to z-scores against the WHO reference. The relationship between aflatoxin exposure and growth was analysed using multi-level modelling. RESULTS Inverse relationships were observed between lnAF-alb and length-for-age (LAZ), weight-for-age (WAZ), and weight-for-length (WLZ) z-scores from 6 to 18 months of age (β = - 0·04, P = 0·015; β = - 0·05, P = 0.003; β = - 0·06, P = 0·007; respectively). There was an inverse relationship between lnAF-alb at 6 months and change in WLZ between 6 and 12 months (β = - 0·01; P = 0·013). LnAF-alb at 12 months was associated with changes in LAZ and infant length between 12 and 18 months of age (β = - 0·01, P = 0·003; β = - 0·003, P = 0·02; respectively). LnAF-alb at 6 months was associated with IGFBP-3 at 12 months (r = - 0·12; P = 0·043). CONCLUSIONS This study found a small but significant effect of aflatoxin exposure on the growth of Gambian infants. This relationship is not apparently explained by aflatoxin induced changes in the IGF-axis.
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Affiliation(s)
- Sinead Watson
- Institute for Global Food Security, School of Biological Sciences, Queen’s University Belfast, Belfast, UK
| | - Sophie E. Moore
- Division of Women’s Health, King’s College London, London, UK
- MRC Unit The Gambia, Serekunda, Gambia
| | | | - Gaoyun Chen
- Institute for Global Food Security, School of Biological Sciences, Queen’s University Belfast, Belfast, UK
| | - Yu-Kang Tu
- Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yi-Ting Huang
- Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kamilla G. Eriksen
- MRC Elsie Widdowson Laboratory, Cambridge, UK
- University of Copenhagen, Copenhagen, Denmark
| | | | - Andrew M. Prentice
- MRC Unit The Gambia, Serekunda, Gambia
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Ya Xu
- School of Medicine, University of Leeds, Leeds, LS2 9JT UK
| | | | - Yun Yun Gong
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
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Eze U, Routledge M, Okonofua F, Huntriss J, Gong Y. Mycotoxin exposure and adverse reproductive health outcomes in Africa: a review. WORLD MYCOTOXIN J 2018. [DOI: 10.3920/wmj2017.2261] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
It is well established that mycotoxin exposure can have adverse effects on reproductive health resulting to poor reproductive potential. The most studied mycotoxin in relation to poor reproductive health in humans is aflatoxin, although fumonisins, trichothecenes and zearalenone have also been reported to impair reproductive function and cause abnormal foetal development. These potent fungal toxins contaminate many food products making them a prominent agricultural, food safety and public health challenge, especially in Africa due to little or lack of mycotoxin regulation in agricultural products. Neonates can be exposed to aflatoxins in utero, as the toxins pass from mother to the foetus through the placenta. This exposure may continue during breast feeding, to the introduction of weaning foods, and then foods taken by adults. The consequences of aflatoxin exposure in mothers, foetus and children are many, including anaemia in pregnancy, low birth weight, interference with nutrient absorption, suppression of immune function, child growth retardation and abnormal liver function. In males, reports have indicated a possible relationship between aflatoxin exposure and poor sperm quality culminating in infertility. Maternal exposure to fumonisin during early pregnancy has been associated with increased risk of neural tube defects among newborns in regions where maize is the common dietary staple with the possibility of chronic fumonisin exposure. Furthermore, zearalenone has been linked to precocious puberty and premature thelarche in girls, correlating with extremely high serum oestrogen levels. This review presents an overview of the several reports linking aflatoxins, fumonisins, trichothecenes, and zearalenone exposure to poor reproductive health outcomes in Africa, with emphasis on birth outcomes, foetal health and infertility.
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Affiliation(s)
- U.A. Eze
- School of Food Science and Nutrition, Food Science Building, University of Leeds, Woodhouse Ln, Leeds LS2 9JT, United Kingdom
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, Ebonyi State University, P.M.B. 053, Abakaliki, Nigeria
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Woodhouse Ln, Leeds LS2 9JT, United Kingdom
| | - M.N. Routledge
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Woodhouse Ln, Leeds LS2 9JT, United Kingdom
| | - F.E. Okonofua
- University of Medical Sciences, Ondo Medical Village, Laje Road, Ondo, Nigeria
- Centre of Excellence in Reproductive Health Innovation [CERHI], University of Benin, P.M.B 1154, Benin City, Nigeria
| | - J. Huntriss
- Division of Reproduction and Early Development, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Woodhouse Ln, Leeds LS2 9JT, United Kingdom
| | - Y.Y. Gong
- School of Food Science and Nutrition, Food Science Building, University of Leeds, Woodhouse Ln, Leeds LS2 9JT, United Kingdom
- Department of Food Safety Risk Assessment, China National Center for Food Safety Risk Assessment, Ministry of Health, 7 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China P.R
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Mutegi CK, Cotty PJ, Bandyopadhyay R. Prevalence and mitigation of aflatoxins in Kenya (1960-to date). WORLD MYCOTOXIN J 2018; 11:341-357. [PMID: 33552311 PMCID: PMC7797628 DOI: 10.3920/wmj2018.2362] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/21/2018] [Indexed: 12/13/2022]
Abstract
Aflatoxins are highly toxic metabolites of several Aspergillus species widely distributed throughout the environment. These toxins have adverse effects on humans and livestock at a few micrograms per kilogram (μg/kg) concentrations. Strict regulations on the concentrations of aflatoxins allowed in food and feed exist in many nations in the developing world. Loopholes in implementing regulations result in the consumption of dangerous concentrations of aflatoxins. In Kenya, where 'farm-to-mouth' crops become severely contaminated, solutions to the aflatoxins problem are needed. Across the decades, aflatoxins have repeatedly caused loss of human and animal life. A prerequisite to developing viable solutions for managing aflatoxins is understanding the geographical distribution and severity of food and feed contamination, and the impact on lives. This review discusses the scope of the aflatoxins problem and management efforts by various players in Kenya. Economic drivers likely to influence the choice of aflatoxins management options include historical adverse health effects on humans and animals, cost of intervention for mitigation of aflatoxins, knowledge about aflatoxins and their impact, incentives for aflatoxins safe food and intended scope of use of interventions. It also highlights knowledge gaps that can direct future management efforts. These include: sparse documented information on human exposure; few robust tools to accurately measure economic impact in widely unstructured value chains; lack of long-term impact studies on benefits of aflatoxins mitigation; inadequate sampling mechanisms in smallholder farms and grain holding stores/containers; overlooking social learning networks in technology uptake and lack of in-depth studies on an array of aflatoxins control measures followed in households. The review proposes improved linkages between agriculture, nutrition and health sectors to address aflatoxins contamination better. Sustained public awareness at all levels, capacity building and aflatoxins related policies are necessary to support management initiatives.
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Affiliation(s)
- C K Mutegi
- International Institute of Tropical Agriculture, IITA, c/o ILRI, P.O. Box 30709, Nairobi 00100, Kenya
| | - P J Cotty
- United States Department of Agriculture, Agricultural Research Service, 416 West Congress Street, Tucson, AZ 85701, USA
| | - R Bandyopadhyay
- International Institute of Tropical Agriculture, IITA, PMB 5320, Ibadan, Nigeria
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Udomkun P, Wossen T, Nabahungu NL, Mutegi C, Vanlauwe B, Bandyopadhyay R. Incidence and farmers' knowledge of aflatoxin contamination and control in Eastern Democratic Republic of Congo. Food Sci Nutr 2018; 6:1607-1620. [PMID: 30258604 PMCID: PMC6145275 DOI: 10.1002/fsn3.735] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/15/2018] [Accepted: 06/18/2018] [Indexed: 11/18/2022] Open
Abstract
Despite efforts to reduce aflatoxin contamination and associated mycotoxin poisoning, the phenomenon continues to pose a public health threat in food and feed commodity chains. In this study, 300 samples of cassava, maize, and groundnut were collected from farmers' households in Eastern DRC and analyzed for incidence of aflatoxins. In addition, the farmers' level of knowledge of the causes and consequences of contamination and the measures for prevention were also examined by administering questionnaires to a cross section of 150 farmers. The results showed the presence of aflatoxins in all samples, with levels ranging from 1.6 to 2,270 μg/kg. In 68% of all samples, total aflatoxin contamination was above 4 μg/kg, the maximum tolerable level set by the European Union. Farmers ranked high humidity, improper storage practices, and poor soils as potential causes of aflatoxin contamination and changes in color, smell, and taste, and difficulty in selling crops as consequences. They identified crop management practices as the most effective way to control contamination. The results also revealed that most farmers apply preharvest crop management practices as a means of controlling contamination. More educated households were more knowledgeable about aflatoxins. Female-headed and married households were less likely to be willing to pay for aflatoxin control. About 28% of farmers claimed to be willing to allocate resources to seed intervention while a smaller proportion agreed to pay for training and information services. The result further suggests that an adoption of pre- and postharvest technologies together with awareness creation is still required to reduce aflatoxin contamination in the country.
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Ratnaseelan AM, Tsilioni I, Theoharides TC. Effects of Mycotoxins on Neuropsychiatric Symptoms and Immune Processes. Clin Ther 2018; 40:903-917. [PMID: 29880330 DOI: 10.1016/j.clinthera.2018.05.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/07/2018] [Accepted: 05/14/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE The effects of air pollutants have been receiving increased attention both clinically and in the media. One such pollutant is mold, fungal growth in the form of multicellular filaments known as hyphae. The growth of molds is omnipresent not only in outdoor settings but also in indoor environments containing excessive amounts of moisture. METHODS PubMed was searched for relevant articles using terms such as mold, mycotoxins, fungi, immunity, inflammation, neurodevelopment, cognition, Alzheimer's, and autism. FINDINGS Exposure to molds is most commonly associated with allergies and asthma. However, it is now thought to be associated with many complex health problems, since some molds, especially Trichoderma, Fusarium and Stachybotrys spp, produce mycotoxins that are absorbed from the skin, airways, and intestinal lining. People exposed to molds and mycotoxins present with symptoms affecting multiple organs, including the lungs, musculoskeletal system, as well as the central and peripheral nervous systems. Furthermore, evidence has recently implicated exposure to mycotoxins in the pathogenesis of autism spectrum disorder. The effects of mycotoxins can be mediated via different pathways that include the secretion of pro-inflammatory cytokines, especially from mast cells. IMPLICATIONS The information reviewed indicates that exposure to mold and mycotoxins can affect the nervous system, directly or through immune cell activation, thus contributing to neurodevelopmental disorders such as autism spectrum disorder.
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Affiliation(s)
- Aarane M Ratnaseelan
- Graduate Program in Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts
| | - Irene Tsilioni
- Molecular Immunopharmacology and Drug Discovery Laboratory, Department of Immunology, Tufts University School of Medicine, Boston, Massachusetts
| | - Theoharis C Theoharides
- Graduate Program in Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts; Molecular Immunopharmacology and Drug Discovery Laboratory, Department of Immunology, Tufts University School of Medicine, Boston, Massachusetts; Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, Massachusetts; Department of Internal Medicine, Tufts University School of Medicine and Tufts Medical Center, Boston, Massachusetts; Department of Psychiatry, Tufts University School of Medicine and Tufts Medical Center, Boston, Massachusetts.
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Leroy JL, Sununtnasuk C, García-Guerra A, Wang JS. Low level aflatoxin exposure associated with greater linear growth in southern Mexico: A longitudinal study. MATERNAL AND CHILD NUTRITION 2018; 14:e12619. [PMID: 29781250 DOI: 10.1111/mcn.12619] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/23/2018] [Accepted: 04/06/2018] [Indexed: 12/23/2022]
Abstract
Aflatoxins are a group of naturally occurring mycotoxins, which can lead to death and are a known cause of hepatocellular carcinoma. AF exposure has been hypothesised to lead to stunted growth in children, but separating the AF effect from other determinants of linear growth retardation is difficult. The study used secondary data from an efficacy trial conducted in young children in southern Mexico to test the comparative efficacy of a milk-based multiple micronutrient-fortified food, a multiple micronutrient syrup, or a multiple micronutrient powder. The effect of serum AFB1 -lysine adduct level on incremental growth was tested using a longitudinal mixed model, controlling for key individual, maternal, and household-level covariates. AFB1 -lysine adduct was detectable in all but 2 of the 347 children in the study (median exposure: 0.82 pg/mg albumin). AF exposure was associated (p < .05) with greater linear growth: an increase equivalent to the sample interquartile range (~0.5 pg AFB1 -lysine/mg albumin) was associated (p < .05) with an increase in the child's height-for-age deficit of 1.5 to 2.0 mm in the 4 months from baseline (average age 8 months) to follow-up (average age 12 months); the magnitude of the difference in the 10-month follow-up was smaller and not statistically significant. This study documents that low-dose AF exposure was associated with greater child linear growth. Given its toxicity and carcinogenicity, our results do not change the urgent need to drastically reduce human AF exposure. Our findings show that the association between AF exposure and linear growth is more complex than previously thought.
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Affiliation(s)
- Jef L Leroy
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Celeste Sununtnasuk
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Armando García-Guerra
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Jia-Sheng Wang
- Department of Environmental Health Sciences, College of Public Health, University of Georgia, Athens, Georgia, USA
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Peanuts, Aflatoxins and Undernutrition in Children in Sub-Saharan Africa. Nutrients 2017; 9:nu9121287. [PMID: 29186859 PMCID: PMC5748738 DOI: 10.3390/nu9121287] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/23/2017] [Accepted: 11/09/2017] [Indexed: 12/30/2022] Open
Abstract
Peanuts (Arachis hypogaea) is an important and affordable source of protein in most of Sub-Saharan Africa (SSA) and a popular commodity and raw material for peanut butter, paste and cooking oil. It is a popular ingredient for foods used at the point of weaning infants from mother's milk. It is at this critical point that childhood undernutrition occurs and the condition manifests as stunting, wasting and growth restriction and accounts for nearly half of all deaths in children under five years of age in SSA. Undernutrition is multi-factorial but weaning foods contaminated with microbiological agents (bacteria and fungi) and natural toxins have been shown to play a big part. While peanuts may provide good nutrition, they are also highly prone to contamination with mycotoxigenic fungi. The high nutritive value of peanuts makes them a perfect substrate for fungal growth and potential aflatoxin contamination. Aflatoxins are highly carcinogenic and mutagenic mycotoxins. This article reviews the nutritional value and aflatoxin contamination of peanuts, the role they play in the development of childhood malnutrition (including the different theories of aetiology) and immunological problems in children. We also discuss the control strategies that have been explored and advocacy work currently taking shape in Africa to create more awareness of aflatoxins and thus combat their occurrence with the goal of reducing exposure and enhancing trade and food safety.
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Kigen G, Busakhala N, Kamuren Z, Rono H, Kimalat W, Njiru E. Factors associated with the high prevalence of oesophageal cancer in Western Kenya: a review. Infect Agent Cancer 2017; 12:59. [PMID: 29142587 PMCID: PMC5670732 DOI: 10.1186/s13027-017-0169-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 10/25/2017] [Indexed: 12/19/2022] Open
Abstract
Oesophageal carcinoma (OC) is highly prevalent in Western Kenya especially among the members of the Kalenjin community who reside in the Northern and Southern areas of the Rift Valley. Previous authors have suggested potential association of environmental and genetic risk factors with this high prevalence. The environmental factors that have been suggested include contamination of food by mycotoxins and/or pesticides, consumption of traditional alcohol (locally referred to “Busaa” and “Chan’gaa”), use of fermented milk (“Mursik”), poor diet, tobacco use and genetic predisposition. The aim of this paper is to critically examine the potential contribution of each of the factors that have been postulated to be associated with the high prevalence of the disease in order to establish the most likely cause. We have done this by analyzing the trends, characteristics and behaviours that are specifically unique in the region, and corroborated this with the available literature. From our findings, the most plausible cause of the high incidence of OC among the Kalenjin community is mycotoxins, particularly fumonisins from the food chain resulting from poor handling of cereals; particularly maize combined with traditional alcohol laced with the toxins interacting synergistically with other high-risk factors such as dietary deficiencies associated alcoholism and viral infections, especially HPV. Urgent mitigating strategies should be developed in order to minimize the levels of mycotoxins in the food chain.
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Affiliation(s)
- Gabriel Kigen
- Department of Pharmacology & Toxicology; Department of Hematology & Oncology, Moi University School of Medicine, P.O. Box 4606-30100, Eldoret, Kenya
| | - Naftali Busakhala
- Department of Pharmacology & Toxicology; Department of Hematology & Oncology, Moi University School of Medicine, P. O. Box 4606-30100, Eldoret, Kenya
| | - Zipporah Kamuren
- Department of Pharmacology & Toxicology, Moi University School of Medicine, P.O. Box 4606-30100, Eldoret, Kenya
| | - Hillary Rono
- Kitale County Hospital; London School of Tropical Medicine & Hygiene, P.O. Box 98-30200, Kitale, Kenya
| | - Wilfred Kimalat
- Retired Permanent Secretary, Ministry of Education, Science & Technology, Provisional Administration & Internal Security, Office of the President, P. O. Box 28467-00200, Nairobi, Kenya
| | - Evangeline Njiru
- Department of Internal Medicine; Department of Hematology and Oncology, Moi University School of Medicine, P.O. Box 4606, Eldoret, 30100 Kenya
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Smith LE, Mbuya MNN, Prendergast AJ, Turner PC, Ruboko S, Humphrey JH, Nelson RJ, Chigumira A, Kembo G, Stoltzfus RJ. Determinants of recent aflatoxin exposure among pregnant women in rural Zimbabwe. Mol Nutr Food Res 2017; 61. [PMID: 28544789 DOI: 10.1002/mnfr.201601049] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 04/12/2017] [Accepted: 04/18/2017] [Indexed: 11/06/2022]
Abstract
SCOPE Aflatoxins (AFs) are toxic secondary metabolites of Aspergillus species that contaminate staple foods such as maize and groundnuts. AF exposure during pregnancy has been associated with adverse birth outcomes in limited-scale surveys in sub-Saharan Africa. The objective of this study was to describe the determinants of AF exposure, using urinary aflatoxin M1 (AFM1) biomarkers and data generated by the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial for rural Zimbabwean women in early pregnancy. Sanitation Hygiene Infant Nutrition Efficacy is a large, cluster-randomized community-based trial in Zimbabwe designed to investigate the independent and combined effects of nutrition and hygiene interventions on early child growth. METHODS AND RESULTS Urine samples collected from 1580 pregnant women in rural Zimbabwe at median gestational age of 13.9 wk were measured for AFM1. AFM1 was detected in 30% of samples (median of exposed, 162 pg AFM1/mg creatinine; range 30-6046 pg AFM1/mg). In multivariable ordinal logistic models, geographical location (p<0.001), seasonality (p < 0.001) and dietary practices (p = 0.011) were significant predictors of urinary AFM1. CONCLUSION This is the largest AF biomarker survey conducted in Zimbabwe, and demonstrated frequent exposure in pregnant women with clear temporal and spatial variability in AF biomarker levels.
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Affiliation(s)
- Laura E Smith
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA.,Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Mduduzi N N Mbuya
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA.,Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrew J Prendergast
- Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Blizard Institute, Queen Mary University of London, London, UK
| | - Paul C Turner
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Sandra Ruboko
- Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Jean H Humphrey
- Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rebecca J Nelson
- School of Integrative Plant Sciences, Cornell University, Ithaca, NY, USA
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Xue KS, Cai W, Tang L, Wang JS. Aflatoxin B1-lysine adduct in dried blood spot samples of animals and humans. Food Chem Toxicol 2016; 98:210-219. [DOI: 10.1016/j.fct.2016.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/30/2016] [Accepted: 11/01/2016] [Indexed: 11/16/2022]
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Schwartzbord JR, Leroy JL, Severe L, Brown DL. Urinary aflatoxin M1 in Port-au-Prince and a rural community in north-east Haiti. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2016; 33:1036-42. [DOI: 10.1080/19440049.2016.1185899] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Jef L. Leroy
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Linda Severe
- Sexually Transmitted Infections Clinic, GHESKIO Centers, Port-au-Prince, Haiti
| | - Dan L. Brown
- Department of Animal Science, Cornell University, Ithaca, NY, USA
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