Nutrition and growth outcomes are affected by aflatoxin exposures in Kenyan children

Aflatoxins in maize and groundnuts on markets in Accra and consumers risk

This study presents the results of aflatoxin contamination of maize and groundnuts in major markets in Accra and assesses the population's exposure to aflatoxins. Raw maize and groundnuts from 6 major markets in Accra were sampled and analysed for their aflatoxin content. A total of 92 samples comprising 48 maize and 44 groundnuts were analysed using high-performance liquid chromatography, after extraction with methanol/water and cleanup on an immunoaffinity column. Total aflatoxins were quantified in 98% of the maize samples and 70% of the groundnut samples, with concentrations ranging from 0.60 to 1065 µg/kg and 0.20 to 627 µg/kg, respectively. Exposure assessment showed an estimated daily intake of 0.436 μg/kg bw/day and 0.0632 μg/kg bw/day for maize and groundnut consumption, respectively, suggesting significant health risks for consumers. The high prevalence and concentrations of aflatoxins call for an urgent need for measures to control exposure of the Ghanaian population.

Neurotoxic mechanisms of mycotoxins: Focus on aflatoxin B1 and T-2 toxin

Aflatoxin B1 (AFB1) and T-2 toxin are commonly found in animal feed and stored grain, posing a serious threat to human and animal health. Mycotoxins can penetrate brain tissue by compromising the blood-brain barrier, triggering oxidative stress and neuroinflammation, and leading to oxidative damage and apoptosis of brain cells. The potential neurotoxic mechanisms of AFB1 and T-2 toxin were discussed by summarizing the relevant research reports from the past ten years. AFB1 and T-2 toxin cause neuronal damage in the cerebral cortex and hippocampus, leading to synaptic transmission dysfunction, ultimately impairing the nervous system function of the body. The toxic mechanism is related to excessive reactive oxygen species (ROS), oxidative stress, mitochondrial dysfunction, apoptosis, autophagy, and an exaggerated inflammatory response. After passing through the blood-brain barrier, toxins can directly affect glial cells, alter the activation state of microglia and astrocytes, thereby promoting brain inflammation, disrupting the blood-brain barrier, and influencing the synaptic transmission process. We discussed the diverse effects of various concentrations of toxins and different modes of exposure on neurotoxicity. In addition, toxins can also cross the placental barrier, causing neurotoxic symptoms in offspring, as demonstrated in various species. Our goal is to uncover the underlying mechanisms of the neurotoxicity of AFB1 and T-2 toxin and to provide insights for future research, including investigating the impact of mycotoxins on interactions between microglia and astrocytes.

Dietary aflatoxins exposure, environmental enteropathy, and their relation with childhood stunting

Childhood stunting is a global phenomenon affecting more than 149 million children under the age of 5 worldwide. Exposure to aflatoxins (AFs) in utero, during breastfeeding, and consumption of contaminated food affect the gut microbiome, resulting in intestinal dysfunction and potentially contributing to stunting. This review explores the potential relationship between AF exposure, environmental enteropathy and childhood stunting. AFs bind to DNA, disrupt protein synthesis and elicit environmental enteropathy (EE). An EE alters the structure of intestinal epithelial cells, impairs nutrient uptake and leads to malabsorption. This article proposes possible intervention strategies for researchers and policymakers to reduce AF exposure, EE and childhood stunting, such as exposure reduction, the implementation of good agricultural practices, dietary diversification and improving environmental water sanitation and hygiene.

A systematic review with meta-analysis of the relation of aflatoxin B1 to growth impairment in infants/children

BACKGROUND

Aflatoxins are regarded as the most potent genotoxic and carcinogenic type of mycotoxins. This meta-analysis was performed to investigate a the relation of aflatoxin B1 (AFB1) to growth measurements of infants/children, including wasting, underweight, stunting, as well as weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WHZ) z-scores.

METHODS

Electronic databases of PubMed, Web of Science, and Scopus were searched to identify related publications. Effect sizes for associations were pooled using the random effects analysis. Subgroup analysis by study design, method used to assess AFB1, and adjustment for covariateswas performed to detect possible sources of heterogeneity.

RESULTS

Pooled analysis of available data showed that AFB1 exposure was negatively associated growth z-scores, including WHZ (β = -0.02, 95%CI = -0.07 to 0.03), with WAZ (β = -0.18, 95%CI = -0.33 to -0.02), and HAZ (β = -0.17, 95%CI = -0.30 to -0.03) in infants/children. There was a remarkable heterogeneity among studies on WAZ and HAZ (P ≤ 0.001). In prospective cohort studies, AFB1 exposure was found to be significantly associated with the elevated risk of underweight (OR = 1.20, 95%CI = 1.03 to 1.40) and stunting (OR = 1.21, 95%CI = 1.11 to 1.33).

CONCLUSIONS

This meta-analysis highlighted the importance of AFB1 exposure as a potential risk factor for growth impairment in infants/children.

A multidisciplinary approach disclosing unexplored Aflatoxin B1 roles in severe impairment of vitamin D mechanisms of action

Aflatoxin B1 (AFB1), produced by fungi of the genus Aspergillus, is the most toxic and carcinogenic mycotoxin among the classes of aflatoxins. Previous research showed that AFB1 affects vitamin D receptor (VDR) expression. In the present study, integrated computational and experimental studies were carried out to investigate how AFB1 can interfere with Vitamin D signalling. A competitive antagonism of AFB1 toward RXRα and VDR was hypothesized by comparing the docked complex of AFB1/RXRα and AFB1/VDR ligand-binding domain (LBD) with the X-ray structures of RXRα and VDR bound to known ligands. Accordingly, we demonstrated that AFB1 can affect vitamin D-mediated transcriptional activation of VDR by impairing the formation of protein complexes containing both VDR-RXRα and RXRα/RAR and affecting the subcellular localization of VDR and RXRα. As a whole, our data indicate that AFB1 can interfere with different molecular pathways triggered by vitamin D with an antagonistic mechanism of action.

Early-life AFB1 exposure: DNA methylation and hormone alterations

Aflatoxins are secondary metabolites of mold that contaminate food and feedstuff. They are found in various food including grains, nuts, milk and eggs. Aflatoxin B1 (AFB1) is the most poisonous and commonly found of the various types of aflatoxins. Exposures to AFB1 start early in life viz. in utero, during breastfeeding, and during weaning through the waning foods which are mainly grain based. Several studies have shown that early-life exposures to various contaminants may have various biological effects. In this chapter, we reviewed the effects of early-life AFB1 exposures on changes in hormone and DNA methylation. In utero AFB1 exposure results in alterations in steroid and growth hormones. Specifically, the exposure results in a reduction in testosterone levels later in life. The exposure also affects the methylation of various genes that are significant in growth, immune, inflammation, and signaling pathways.

Aflatoxin in cereals and groundnut from small holder farming households in Malawi

Aflatoxin contamination in commonly consumed cereals and nuts may place children at higher risk of stunting and adults at risk of developing liver cancer. This study investigated knowledge on aflatoxins and the level of aflatoxin B₁ contamination in commonly consumed cereals and nuts in Malawi. It also included an examination of the proportion of cereals and nuts contaminated above regulatory maximum limits. Aflatoxin contamination in samples was assessed using an enzyme-linked immunosorbent assay (ELISA) method. Less than half of all households knew that consumption of aflatoxin contaminated grain is associated with stunting and lowered immunity. Sorghum samples were the most contaminated and millet the least contaminated. Aflatoxin contamination was highest in southern Malawi and least in northern Malawi. Observed results indicate that this population is at risk of poor health due to lack of knowledge and aflatoxin exposure. Strategies to address contamination should therefore include a comprehensive education campaign to increase knowledge and promote accessible strategies.

Assessing an aflatoxin exposure biomarker: Exploring the interchangeability and correlation between venous and capillary blood samples

Exposure to dietary aflatoxins has been recognized as a potential threat to child nutrition and growth, in addition to being a known carcinogen. The ability to accurately assess concentration of aflatoxin in the blood of at-risk individuals is therefore very important to inform public health policies and on-the-ground programs around the world. Venous blood is frequently used to quantify biomarkers of exposure such as AFB1-lysine adducts. However, venous blood collection methods are invasive, requiring highly trained staff, which makes this method challenging to implement, especially in resource-limited settings. In contrast, capillary blood collection by fingerprick is less invasive and has the potential for application in point-of-need monitoring. The aim of this exploratory study was to investigate the correlation and interchangeability of capillary and venous human blood samples in the quantification of AFB1-lysine adduct concentration. A total of 72 venous and capillary blood samples were collected from 36 women of reproductive age (16-49 years) in northern Uganda. All sample specimens were analyzed using high-performance liquid chromatography with fluorescence detection. Regression analysis and Bland-Altman analysis were performed to compare AFB1-lysine concentrations between venous and capillary sample pairs. Bland-Altman analysis of albumin-normalized AFB1-lysine data-bias was -0.023 pg/mg-albumin and the 95% limits of agreement were 0.51 to -0.56 pg/mg-albumin for log-transformed data. There was a positive correlation between albumin-normalized venous and capillary AFB1-lysine concentrations with r of 0.71 (p < .0001). A lack of any accepted clinical cutoff for aflatoxin exposure makes definition of an 'acceptable' limit for statistical analysis and comparison of methods challenging. Our data suggests a positive correlation between albumin-normalized AFB1-lysine concentrations in venous and capillary sample pairs, but relatively weak agreement and interchangeability based on Bland-Altman analysis.

Impact of dietary aflatoxin on immune development in Gambian infants: a cohort study

BACKGROUND

Chronic aflatoxin (AF) exposure has been shown to occur at high levels in children from sub-Saharan Africa (SSA), and has been associated with growth retardation and immune dysfunction. Our objective was to investigate the impact of AF exposure on immune development in early infancy using thymic size and antibody (Ab) response to vaccination as indicators of immune function.

METHODS

A total of 374 infants born between May 2011 and December 2012 were enrolled into the current study. These infants were recruited from a larger, randomised trial examining the impact of nutritional supplementation of mothers and infants on infant immune development (the Early Nutrition and Immune Development Trial). Thymic size (Thymic Index, TI) was measured by sonography at 1 week, 8 weeks, 24 weeks and 52 weeks of infant age. Infants were given the diphtheria-tetanus-pertussis (DTP) vaccine at 8 weeks, 12 weeks and 16 weeks of age, and Ab responses to each vaccine measured at 12 weeks and 24 weeks of age. AF-albumin (AF-alb) adduct levels in infant blood were measured by ELISA as the biomarker of AF exposure.

RESULTS

The geometric mean (GM) level of AF-alb increased with age. Only half of infants had detectable AF-alb with a GM of 3.52 pg/mg at 24 weeks, increasing to 25.39 pg/mg at 52 weeks, when 98% of infants had AF-alb >limit of detection. Significant negative association of AF-alb level with TI was seen in infants during the first 24 weeks, especially at 8 weeks of age (p<0.001), which is the time point of fastest thymus growth. There were no associations between AF exposure level and Ab response to pertussis and tetanus, but a significant positive correlation was observed between AF-alb level and Ab titre to diphtheria (p<0.005).

CONCLUSIONS

High levels of AF exposure during early infancy may impact on infant immune development.

TRIAL REGISTRATION NUMBER

ISRCTN49285450.