Aflatoxin M1in breast-milk of UAE women

Aflatoxin M1 in milk and dairy products: The state of the evidence for child growth impairment

Aflatoxin M1 (AFM1) is a metabolite of the more toxic aflatoxin B1 (AFB1) a mycotoxin produced by the fungi Aspergillus flavus and A. parasiticus; which contaminates maize, peanuts, tree nuts, and oilseeds, among other crops in warm regions of the world. When mammals consume AFB1 in these foods, they secrete AFM1 in milk. A recent analysis indicated negligible cancer risk associated with AFM1 exposure, but whether AFM1 impairs children's growth is important to understand because children consume relatively more milk than adults worldwide. Our paper reviews the evidence on the link between AFM1 exposure and child growth impairment. We find that the existing studies are contradictory and necessitates further studies on this question; in particular, those that control for potentially confounding factors such as household socioeconomic status, children's overall diets, hygienic factors, and agroecological zone. Though many nations have policies for maximum AFM1 limits in dairy foods, they are not based on an explicit health risk analysis of AFM1 but on conversion rates of AFB1 levels to AFM1 in dairy products. Future studies on AFM1's potential harmful effects on child growth will help to better inform policies on maximum allowable AFM1 in milk and other dairy products.

Mycotoxin contamination in the Arab world: Highlighting the main knowledge gaps and the current legislation

Since the discovery of aflatoxins in the 1960s, knowledge in the mycotoxin research field has increased dramatically. Hundreds of review articles have been published summarizing many different aspects, including mycotoxin contamination per country or region. However, mycotoxin contamination in the Arab world, which includes 22 countries in Africa and Asia, has not yet been specifically reviewed. To this end, the contamination of mycotoxins in the Arab world was reviewed not only to profile the pervasiveness of the problem in this region but also to identify the main knowledge gaps imperiling the safety of food and feed in the future. To the best of our knowledge, 306 (non-)indexed publications in English, Arabic, or French were published from 1977 to 2021, focusing on the natural occurrence of mycotoxins in matrices of 14 different categories. Characteristic factors (e.g., detected mycotoxins, concentrations, and detection methods) were extracted, processed, and visualized. The main results are summarized as follows: (i) research on mycotoxin contamination has increased over the years. However, the accumulated data on their occurrences are scarce to non-existent in some countries; (ii) the state-of-the-art technologies on mycotoxin detection are not broadly implemented neither are contemporary multi-mycotoxin detection strategies, thus showing a need for capacity-building initiatives; and (iii) mycotoxin profiles differ among food and feed categories, as well as between human biofluids. Furthermore, the present work highlights contemporary legislation in the Arab countries and provides future perspectives to mitigate mycotoxins, enhance food and feed safety, and protect the consumer public. Concluding, research initiatives to boost mycotoxin research among Arab countries are strongly recommended.

Human Breast Milk Contamination with Aflatoxins, Impact on Children's Health, and Possible Control Means: A Review

Aflatoxins are natural toxicants produced mainly by species of the Aspergillus genus, which contaminate virtually all feeds and foods. Apart from their deleterious health effects on humans and animals, they can be secreted unmodified or carried over into the milk of lactating females, thereby posing health risks to suckling babies. Aflatoxin M1 (AFM1) is the major and most toxic aflatoxin type after aflatoxin B1 (AFB1). It contaminates human breast milk upon direct ingestion from dairy products or by carry-over from the parent molecule (AFB1), which is hydroxylated in the liver and possibly in the mammary glands by cytochrome oxidase enzymes and then excreted into breast milk as AFM1 during lactation via the mammary alveolar epithelial cells. This puts suckling infants and children fed on this milk at a high risk, especially that their detoxifying activities are still weak at this age essentially due to immature liver as the main organ responsible for the detoxification of xenobiotics. The occurrence of AFM1 at toxic levels in human breast milk and associated health conditions in nursing children is well documented, with developing countries being the most affected. Different studies have demonstrated that contamination of human breast milk with AFM1 represents a real public health issue, which should be promptly and properly addressed to reduce its incidence. To this end, different actions have been suggested, including a wider and proper implementation of regulatory measures, not only for breast milk but also for foods and feeds as the upstream sources for breast milk contamination with AFM1. The promotion of awareness of lactating mothers through the organization of training sessions and mass media disclosures before and after parturition is of a paramount importance for the success of any action. This is especially relevant that there are no possible control measures to ensure compliance of lactating mothers to specific regulatory measures, which can yet be appropriate for the expansion of breast milk banks in industrialized countries and emergence of breast milk sellers. This review attempted to revisit the public health issues raised by mother milk contamination with AFM1, which remains undermined despite the numerous relevant publications highlighting the needs to tackle its incidence as a protective measure for the children physical and mental health.

Determination of aflatoxin M1 in breast milk and related factors

OBJECTIVE:

Breastfeeding in women with aflatoxin M1 exposure may be a risk factor for the newborn. Thus, it is crucial to determine aflatoxin M1 levels in breast milk and raise mothers’ awareness about nutrition in lactation and other periods. This study was carried out to determine aflatoxin M1 contamination in milk samples taken from mothers who gave birth.

METHODS:

The study was carried out in the postpartum department of Training and Research Hospital between December 31, 2018, and June 31, 2019, and 90 breastfeeding mothers were included in the study.

RESULTS:

A total of 75 (83.3%) of the examined samples were found positive. The mean aflatoxin M1 ratio in positive samples was 12.16 pg/mL (5.00–23.18 pg/mL). Mothers’ consumption of processed food was associated with aflatoxin M1 levels (p=0.043). It was determined that the aflatoxin M1 levels of mothers who consumed processed food products 1 or 2 times a month were 3.22 times lower than those who consumed 1–2 times a week.

CONCLUSIONS:

This study emphasized the importance of monitoring aflatoxin M1 levels in breast milk for infant health. It is thought that nutrition education given to mothers during pregnancy will significantly impact aflatoxin M1 results. In addition, the dangers of mycotoxins in mother-infant nutrition should be emphasized regularly in health education.

Influence of season and lactational stage on aflatoxin M1 and ochratoxin A in human milk in a cohort study from southeastern region of Turkey

The aim was to evaluate the changes in aflatoxin M1 (AFM1) and ochratoxin A (OTA) levels in human breast milk (HBM) during the first five postpartum months according to the sampling season in a cohort study from Şanlıurfa. From 78 healthy lactating mothers, HBM was taken at the 5-14 days postpartum (D5-14) and the 6^th and 18^th weeks postpartum (W6 and W18). Mycotoxin levels were analyzed with competitive ELISA. Generalized Estimating Equations with repeated measures (three-correlation matrix dimension) revealed a significantly higher mean AFM1 level at W6 than that on D5-14. AFM1 and OTA levels in winter and spring were considerably higher than that in summer and autumn. Maternal smoke exposure, body mass index, history of moldy food exposure, birth order, and breastfeeding type did not influence the results. Whilst season had a marked effect on the milk levels of both analytes, lactation stage affected AFM1 more notable than OTA.

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

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

Aflatoxin contamination of human breast milk and complementary foods in southern Ethiopia

Exposure to unsafe level of aflatoxin in early life may lead to growth faltering. However, the extent of contamination of breast milk and complementary foods is poorly examined. We determined aflatoxin M₁ (AFM₁ ) and B₁ (AFB₁ ) contamination of human breast milk and cereal-based cooked complementary foods, respectively, among households having children 6-23 months of age in Sidama zone, southern Ethiopia. Data were collected through two cross-sectional surveys implemented in the wet (n = 180) and dry (n = 180) seasons. Eligible households (n = 360) were recruited from three agroecological zones (lowland, midland and highland, each with sample size of 120) using a multistage sampling technique. AFB₁ and AFM₁ levels were determined using enzyme-linked immunosorbent assay. Mann-Whitney U and Kruskal-Wallis tests were performed to compare aflatoxin levels between seasons and across the agroecological zones. Among 360 breast milk samples tested, 64.4% had detectable AFM₁ and 5.3% exceeded the 0.025 parts per billion (ppb) limit set by the European Union for infant milk. The median AFM₁ in the lowlands was significantly higher than in the other agroecological settings (P < 0.001). By season, AFM₁ was higher in breast milk samples collected in the dry season (P = 0.041). AFB₁ was detected in 96.4% of the food samples tested, and 95.0% had concentration exceeding the permissible European Union limit of 0.1 ppb. The median AFB₁ was significantly higher in the lowland (P = 0.002), but there was no difference between the seasons (P = 0.386). The study indicated that, in southern Ethiopia, foods intended for infants are heavily contaminated with AFB₁ . Contamination of breast milk is also a significant health concern.

Aflatoxin M1 in Milk Worldwide from 1988 to 2020: A Systematic Review and Meta-Analysis

Background. Aflatoxins are found in various types of food and animal feed. Food contamination with aflatoxin toxin is of particular importance today. Various studies have reported different prevalence of aflatoxin M1 in animal milk. Therefore, due to the importance of this toxin, its role in health, and lack of general statistics about it worldwide, the present study aimed to determine the prevalence of aflatoxin M1 in milk worldwide with a systematic review and meta-analysis study. Methods. In this review study, national and international databases were extracted from SID, MagIran, IranMedex, IranDoc, Embase, ScienceDirect, Scopus, PubMed, and Web of Science (ISI) between January 1988 and February 2020. A random effects model was used for analysis, and heterogeneity of studies with an I2 index was investigated. Data were analyzed using Comprehensive Meta-Analysis (version 2). Results. The prevalence of aflatoxin M1 in milk worldwide from January 1988 to February 2020 in 122 articles with a sample size of 18921 was 79.1% (95% CI: 75.5–82.3%). Regarding the heterogeneity based on metaregression, there was a significant difference between the effect of the year of study (p≤0.001) and sample size (p≤0.001) with the prevalence of aflatoxin M1 in animal milk. Conclusion. The results of this study show that the prevalence of aflatoxin M1 in milk is high worldwide. Therefore, considering the importance of the milk group and its products, special measures should be taken to protect the ration from aflatoxin molds and milk quality.

Aflatoxin exposure in utero and birth and growth outcomes in Tanzania

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.

Aflatoxin M1 binding by lactic acid bacteria in milk

This research focused on biocontrol solution to increase food safety through studying lactic acid bacteria (LAB) which can bind aflatoxins in milk. Aflatoxins are toxic contaminants found in feeds and foods. In milk aflatoxin is found in metabolised form, aflatoxin M1 (AFM1). Three indigenous LAB Lactobacillus strains and one Lactococcus strain isolated from Kenyan spontaneously fermented foods were tested for their AFM1 binding abilities in different conditions and after different treatments along with two reference Lactobacillus strains. Binding of AFM1 in different concentrations was examined with unconcentrated, concentrated, heat treated and concentrated heat-treated LAB cultures. Observed binding of AFM1 by LAB varied between 11 to 100%, being approximately at the level of 40% throughout the analysis sets. The results of this study suggest that the aflatoxin binding ability by LAB strain is not strongly strain specific and depends on many external and condition variables. Also, the methods used in determination of aflatoxin binding warrant critical evaluation.

Aflatoxins in rice: Worldwide occurrence and public health perspectives

Aflatoxins are fungal secondary metabolites that contaminate dietary staples worldwide, including maize, rice and groundnuts. Dietary exposure to aflatoxins is a public health concern due to their carcinogenic, acute and chronic effects. Rice is an important staple food consumed widely and consists of a major part of the diets for half of the world population. Human exposure to these mycotoxins is a serious problem especially in developing countries where hot and humid climates favor the fungal growth and where food storage conditions are poor and lack of regulatory limits enforcement. The recent developments of biomarkers have provided opportunities in assessing aflatoxins exposure and related health effects in the high-risk population groups. This review describes the worldwide occurrence of aflatoxins in rice during the period from 1990 to 2015 and biomarkers-based evidence for human exposure to aflatoxins and their adverse health effects. Aflatoxin is a potent hepatocarcinogen and humans may expose to it at any stage of life. Epidemiological studies reported an association between aflatoxin intake and the incidence of hepatocellular carcinoma in some sub-Saharan and Asian countries. Even daily high intake of rice with a low level of contamination is of health concern. Thus, it is necessary to implement effective strategies to prevent contamination and fungal growth in rice. A good agricultural and manufacturing practice should be applied during handling, storage and distribution of rice to ensure that aflatoxins contamination level is lower in the final product. Moreover, a regular survey for aflatoxins occurrence in rice and biomarkers-based studies is recommended to prevent and reduce the adverse health effects in the world population.

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

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

A Risk Assessment of Aflatoxin M1 Exposure in Low and Mid-Income Dairy Consumers in Kenya

Aflatoxin M₁ (AFM₁), a human carcinogen, is found in milk products and may have potentially severe health impacts on milk consumers. We assessed the risk of cancer and stunting as a result of AFM₁ consumption in Nairobi, Kenya, using worst case assumptions of toxicity and data from previous studies. Almost all (99.5%) milk was contaminated with AFM₁. Cancer risk caused by AFM₁ was lower among consumers purchasing from formal markets (0.003 cases per 100,000) than for low-income consumers (0.006 cases per 100,000) purchasing from informal markets. Overall cancer risk (0.004 cases per 100,000) from AFM₁ alone was low. Stunting is multifactorial, but assuming only AFM₁ consumption was the determinant, consumption of milk contaminated with AFM₁ levels found in this study could contribute to 2.1% of children below three years in middle-income families, and 2.4% in low-income families, being stunted. Overall, 2.7% of children could hypothetically be stunted due to AFM₁ exposure from milk. Based on our results AFM₁ levels found in milk could contribute to an average of -0.340 height for age z-score reduction in growth. The exposure to AFM₁ from milk is 46 ng/day on average, but children bear higher exposure of 3.5 ng/kg bodyweight (bw)/day compared to adults, at 0.8 ng/kg bw/day. Our paper shows that concern over aflatoxins in milk in Nairobi is disproportionate if only risk of cancer is considered, but that the effect on stunting children might be much more significant from a public health perspective; however, there is still insufficient data on the health effects of AFM₁.

Effect of aflatoxin B1 on blood serum oestradiol-17β and progesterone concentrations during the luteal phase and the synchronized oestrus of goats

The effect of prolonged aflatoxin B₁ (AFB₁) administration on blood serum oestradiol-17β and progesterone concentrations in goats during the luteal phase and the synchronized oestrus was investigated. Thirty-six Greek indigenous primiparous goats were used, during the oestrus period; 12 goats received, per os, 50 μg (treated group T50) and 12 goats received 100 μg (treated group T100) AFB₁/day/head, respectively, for approximately 1.5 month, while 12 goats served as controls (C). On day 36 of the experiment, each goat was injected, i.m, 0.5 ml prostaglandin F_2α (PGF_2α). Blood samples were collected from each goat twice a week, before PGF_2α injection, as well as every 4 hours from the onset to the end of the synchronized oestrus. Oestradiol-17β and progesterone concentrations in blood serum were determined using radioimmunoassay. During the whole luteal(s) phase(s), linear regression analysis revealed a significant negative dependence (P < 0.05) of oestradiol-17β and a significant positive dependence (P < 0.05) of progesterone over group (C = 0, T50 = 50, T100 = 100), in a dose dependent manner. During the synchronized oestrus, multiple linear regression analysis revealed a significant negative dependence (P < 0.05) of oestradiol-17β, as well as a significant positive dependence (P < 0.05) of progesterone over group (C = 0, T50 = 50, T100 = 100) and over time (hours, from the onset to the end of the synchronized oestrus). No significant differences were noticed among the three groups, regarding the body weight of the goats from the onset to the end of AFB₁ administration, the occurrence or the duration of the synchronized oestrus presented by the goats (P > 0.05). In conclusion, prolonged AFB₁ administration at doses of 100 or even of 50 μg/day/head changes the hormonal pattern in blood during the luteal phase and the synchronized oestrus of goats, being in oestrus period.

Analysis of Aflatoxin M1 in Breast Milk and Its Association with Nutritional and Socioeconomic Status of Lactating Mothers in Lebanon

Aflatoxin B₁ (AFB₁) is the most potent of the dietary aflatoxins, and its major metabolite, aflatoxin M₁ (AFM₁), is frequently found in the breast milk of lactating mothers. The aim of this study was to assess the occurrence and factors associated with AFM₁ contamination of breast milk collected from lactating mothers in Lebanon. A total of 111 breast milk samples were collected according to the guidelines set by the World Health Organization. Samples were analyzed with a competitive enzyme-linked immunosorbent assay between December 2015 and November 2016. A survey was used to determine the demographic and anthropometric characteristics of participating lactating mothers. Dietary habits were assessed using a semiquantitative food frequency questionnaire. Mean (±standard deviation) concentration of AFM₁ in the breast milk samples was 4.31 ± 1.8 ng/L, and 93.8% of samples contained AFM₁ at 0.2 to 7.9 ng/L. The mean concentration of AFM₁ was significantly lower (P < 0.05) in fall and winter (4.1 ± 1.9 ng/L) than in spring and summer (5.0 ± 1.7 ng/L). None of the samples exceeded the European Commission regulation limit (25 ng/L) for infant milk replacement formula. AFM₁ contamination was significantly associated (P < 0.05) with the daily consumption of white cheeses but not with the consumption of meat or cereal products. No significant association (P > 0.05) was observed between AFM₁ concentrations in breast milk and anthropometric sociodemographic factors (age and level of education) or the governorate of residence of the nursing mothers. The mean AFM₁ estimated daily intake was found to be 0.69 ng/day/kg of body weight. Although the incidence of AFM₁ contamination was low, our first-of-its-kind study highlights the importance of conducting investigations on mycotoxin contamination in breast milk and of developing protection strategies to tackle the exposure of infants to this potent chemical hazard.

Mycotoxins in milk for human nutrition: cow, sheep and human breast milk

Mycotoxins are produced pre harvest by some molds and secreted into various food items of plant origin, such cereals, vegetables, spices, coffee and nuts. If the food items are not stored under adequate conditions, a post harvest contamination may also occur. Animals and humans take them up by food items and some of them are stored and accumulated in different tissues and organs, so that food of animal origin may be contaminated, too. Especially aflatoxin and ochratoxin are secreted into milk by consumers of contaminated food. Since milk represents the major food source of newborns and infants, they are notably exposed to these mycotoxins. This health risk for these individuals may be of particular importance, because their ability to metabolize these fungal toxic agents is not yet fully developed at this stage.

Exposure of Infants to Aflatoxin M1 from Mother's Breast Milk in Ilam, Western Iran

Objectives

Aflatoxins as a highly toxic group of mycotoxins are present in the environment and foodstuff. These have been reported to cause serious health problems in humans. Since aflatoxin M1 (AFM1) is excreted into breast milk, investigating the exposure of infants to AFM1 is of special concern.

Methods

In the present study, breast milk samples were collected from 85 lactating mothers in Ilam province, Iran, and the levels of AFM1 were analyzed using the enzyme-linked immunosorbent assay-based technique. AFM1 was detected in breast milk of all lactating women. The mean contamination level was 5.91 ± 2.031 ng/L, ranging from 2 ng/L to 10 ng/L.

Results

Multiple regression analysis indicated no significant associations of consumption of milk and dairy products, meat, fish, legumes, grain products, fruits, and nuts with the concentration of AFM1 in breast milk. Furthermore, no significant association was observed between AFM1 concentration and anthropometric data of infants.

Conclusion

In western parts of Iran, lactating mothers and their infants could be at risk of aflatoxin B1 and AFM1 exposure, respectively. Therefore, in Iran, the evaluation of AFM1 in human breast milk as a biomarker for postnatal exposure of infants to this carcinogen requires more attention in different regions and various seasons.

Determination of aflatoxin M1 in breast milk as a biomarker of maternal and infant exposure in Colombia

Chronic exposure to aflatoxins, and especially to aflatoxin B1 (AFB1), causes hepatocellular carcinoma with prevalence 16-32 times higher in developing compared with developed countries. Aflatoxin M1 (AFM1) is a monohydroxylated metabolite from AFB1 that is secreted in milk and which can be used as a biomarker of AFB1 exposure. This study aimed to determine AFM1 levels in human breast milk using immunoaffinity column clean-up with HPLC and fluorescence detection. Breast milk samples were obtained from 50 nursing mothers. Volunteers filled in a questionnaire giving their consent to analyse their samples as well as details of their socioeconomic, demographic and clinical data. The possible dietary sources of aflatoxins were assessed using a food frequency questionnaire. A total of 90% of the samples tested positive for AFM1, with a mean of 5.2 ng l(-1) and a range of 0.9-18.5 ng l(-1). The study demonstrated a high frequency of exposure of mothers and neonates to AFB1 and AFM1 in Colombia, and it points out the need to regulate and monitor continuously the presence of aflatoxins in human foods. Further research is needed in order to determine the presence of other mycotoxins in foods and in human samples as well as to devise protection strategies in a country where mycotoxins in human foods are commonly found.

The concentration of aflatoxin M1 in the mothers' milk in Khorrambid City, Fars, Iran

INTRODUCTION

Aflatoxins are secondary toxic metabolites produced by certain group of Aspergillus species in suitable conditions. These toxins are highly toxic, immunosuppressive, mutagenic, teratogenic and carcinogenic metabolites. The purpose of this study was to detection aflatoxin M1 concentration in mother's milk from rural area of Khorrambid town of Fars Province.

MATERIALS AND METHODS

In this study, 87 milk samples of mothers were collected by cluster sampling methods in the period between June and July 2011 and the amount of aflatoxin M1 was measured by a competitive ELISA method.

RESULTS

From 87 mother's milk, 24 (27.6%) samples were contaminated with aflatoxin M1 with mean concentration of 0.56 ± 1.23 pg/ml (range 0.13-4.91 pg/ml).

CONCLUSION

The amount of aflatoxin M1 in mothers' milk was lower than 50 ng/l (Europe Union and Iranian standard). Detection of Aflatoxin M1 in mothers' milk is due to consuming contaminated food. This contamination not only threatens the health of the mothers but also has irreversible effects on the growth and health of their babies.

The molecular epidemiology of chronic aflatoxin driven impaired child growth

Aflatoxins are toxic secondary fungal metabolites that contaminate dietary staples in tropical regions; chronic high levels of exposure are common for many of the poorest populations. Observations in animals indicate that growth and/or food utilization are adversely affected by aflatoxins. This review highlights the development of validated exposure biomarkers and their use here to assess the role of aflatoxins in early life growth retardation. Aflatoxin exposure occurs in utero and continues in early infancy as weaning foods are introduced. Using aflatoxin-albumin exposure biomarkers, five major studies clearly demonstrate strong dose response relationships between exposure in utero and/or early infancy and growth retardation, identified by reduced birth weight and/or low HAZ and WAZ scores. The epidemiological studies include cross-sectional and longitudinal surveys, though aflatoxin reduction intervention studies are now required to further support these data and guide sustainable options to reduce the burden of exposure. The use of aflatoxin exposure biomarkers was essential in understanding the observational data reviewed and will likely be a critical monitor of the effectiveness of interventions to restrict aflatoxin exposure. Given that an estimated 4.5 billion individuals live in regions at risk of dietary contamination the public health concern cannot be over stated.

Aflatoxins and growth impairment: a review

Aflatoxins, fungal toxins produced by Aspergillus flavus and Aspergillus parasiticus in a variety of food crops, are well known as potent human hepatocarcinogens. Relatively less highlighted in the literature is the association between aflatoxin and growth impairment in children. Foodborne aflatoxin exposure, especially through maize and groundnuts, is common in much of Africa and Asia--areas where childhood stunting and underweight are also common, due to a variety of possibly interacting factors such as enteric diseases, socioeconomic status, and suboptimal nutrition. The effects of aflatoxin on growth impairment in animals and human children are reviewed, including studies that assess aflatoxin exposure in utero and through breastfeeding. Childhood weaning diets in various regions of the world are briefly discussed. This review suggests that aflatoxin exposure and its association with growth impairment in children could contribute a significant public health burden in less developed countries.

Assessment of exposure of Egyptian infants to aflatoxin M1 through breast milk

BACKGROUND

Mothers are exposed to many toxins that can reach their infants through breast milk. One of these toxins is aflatoxins, produced by Aspergillus fungus. Aspergillus colonizes grains, especially in tropical regions where there is high temperature and humidity. Aflatoxins are highly toxic, mutagenic, teratogenic, and carcinogenic. One of these is aflatoxin B1 that is excreted in breast milk as aflatoxin M1 (AFM1).

MATERIALS AND METHODS

This is a cross-sectional study in which 150 mother-infant dyads were included. All the infants were exclusively breastfed. Infant weights' standard deviation scores were documented at birth and at 6 months. At 6 months, before starting weaning, AFM1 was measured in breast milk by enzyme-linked immunosorbent assay and by liver enzymes; alanine aminotransferase (ALT) and aspartate aminotransferase (AST) for all mothers and infants.

RESULTS

Ninety-eight mothers (65.3%) had AFM1-positive breast milk samples (AFM1>0.05 μg/l according to the European Community and Codex Alimentarius). AFM1 levels ranged between 0.2 and 19.0 μg/l (mean: 7.1±5.0 μg/l). In cases considered negative, AFM1 levels ranged between 0.01and 0.05 μg/l (mean: 0.04±0.01 μg/l). Infants of AFM1-positive mothers had lower weight standard deviation scores at birth and at 6 months (P=0.04 and 0.0001). ALT and aspartate aminotransferase of mothers and ALT of infants were significantly higher in dyads having AFM1-positive breast milk (P=0.0001, 0.0001, and 0.03, respectively).

CONCLUSION

Aflatoxins represent a real threat in Egypt. The higher liver enzymes in AFM1-positive cases might represent an alarm toward future development of hepatocellular carcinoma.

RECOMMENDATIONS

Cooperation of ministries is recommended to combat this problem. The public should be educated about proper food storage and about the hazards of aflatoxin ingestion.

Toxicokinetics of aflatoxin in pregnant mice

Our objective was to study the toxicokinetics of aflatoxin (AF) in pregnant mice. Aflatoxin B1 (AFB1) was administered intraperitoneally (IP) to groups of pregnant mice in single doses of 20 mg/kg on gestation day (GD) 13 and orally at the same gestational age. Controls received (IP and oral) a proportionate volume of solvent only. Maternal blood was collected at 15, 30, 45, 60, 90, 120, and 150 minutes posttreatment. Their AFB1 contents were determined. Aflatoxin B1 concentrations following maternal exposure to AFB1 were highly correlated with time after exposure. The serum concentrations were predictable and the highest serum levels were seen immediately at 15 minutes in mice given AFs IP and at 30 minutes in those given it orally. The absorption was 5.0 microg/min and elimination was 3.0 microg/min. The toxicokinetics of AFB1 have been delineated. Aflatoxins are easily and rapidly absorbed both from the gastrointestinal tract (GI) tract and through the peritoneum.

Association between birth outcomes and aflatoxin B1 biomarker blood levels in pregnant women in Kumasi, Ghana

OBJECTIVE

To investigate the association between birth outcomes and blood levels of aflatoxin B(1) (AFB1)-lysine adduct in pregnant women in Kumasi, Ghana.

METHOD

A cross-sectional study of 785 pregnant women attending antenatal clinic was conducted. Aflatoxin B(1) (AFB(1))-lysine adduct levels were determined by high performance liquid chromatography (HPLC) on blood taken after delivery. The birth outcomes considered were small for gestation age, low birthweight, preterm delivery and stillbirth. Participants were divided into quartiles based on the distribution of aflatoxin B(1)-lysine adducts in pg/mg albumin ('low': <or=2.67, 'moderate': >2.67 to <or=4.97, 'high': >4.97 to <or=11.34, 'very high': >11.34). Statistical analysis involved models that included socio-demographic variables and other potential confounders.

RESULTS

The average AFB(1)-lysine adduct level in maternal serum was 10.9 +/- 19.00 pg/mg albumin (range = 0.44-268.73 pg/mg). After adjusting for socio-demographic variables and potential confounding factors, participants in the highest AFB(1)-lysine quartile with 'very high' AFB(1)-lysine level (>11.34 pg/mg) were more likely to have low birthweight babies (OR, 2.09; 95% CI, 1.19-3.68), and showed a trend of increasing risk for low birthweight (P(trend) = 0.007) compared to participants in the lowest quartile.

CONCLUSION

This study adds to the growing body of evidence that aflatoxins may increase the risk of adverse birth outcomes. The findings have implications for targeted nutritional education of pregnant women in areas with high levels of aflatoxin contamination of foods.

Exposure of newborns to aflatoxin M1 and B1 from mothers' breast milk in Ankara, Turkey

Aflatoxins (AFs) are important risks for human health due to their widespread presence in foods and environment. However, contamination risk of breast milk with different pollutants including AFs is high in today's life conditions. Since breast milk is a major nutrient for infants, feeding of infants with safe milk is essential. Therefore, the objective of this study was to determine the levels of AF M(1) and B(1) in breast milk samples collected from 75 mothers in Ankara, Turkey. AF M(1) and B(1) levels were investigated by high performance liquid chromatography (HPLC) with a fluorescence detector following an extraction procedure. The limit of detection was found to be 5 ng/l. Both AFs were detected in diverse degrees in all breast milk samples: The level of AF M(1) were in the ranges of 60.90-299.99 ng/l, and AF B(1) were in the ranges of 94.50-4123.80 ng/l. These results pointed out the exposure of mothers and neonates to AF M(1) and B(1), and the necessity of further research on mycotoxin contamination both in foods and biological fluids as well as protection strategies.

Mycotoxins and child health: the need for health risk assessment

The occurrences of mycotoxins as food contaminants in different localities particularly in developing countries and the inevitable exposure of populations and children to these toxins with probable adverse outcomes need be scientifically and systematically assessed. Health risk assessment developed in the 1980s is separate from risk management, both with risk communication form the risk analysis framework adopted by the World Health Organization. The process contributes increasingly to policy development, public health decision making, the establishment of mycotoxin regulations and research planning. However, the exercise of the risk assessment structured approach is not simple and is faced up to lack of data, capable infrastructure facilities and need for trained personnel and resources. Furthermore, adopted methodologies need be developed focusing on child characteristics and health concerns.

Detection of aflatoxin M1 in human breast milk and raw cow's milk in Istanbul, Turkey

This survey was undertaken to determine the extent of aflatoxin M1 (AFM1) contamination in human breast milk and raw cow's milk in Istanbul, Turkey. Samples of human and raw cow's milk were collected randomly and analyzed for AFM1 using an enzyme-linked immunosorbent assay and high-performance liquid chromatography with fluorescence detection in which the samples were cleaned up with immunoaffinity columns. In this study, AFM, was detected in 8 (13.1%) of 61 human breast milk samples examined (mean +/- SD level, 5.68 +/- 0.62 ng/liter; range, 5.10 to 6.90 ng/liter) and 20 (33.3%) of 60 raw cow's milk samples examined (range, 5.40 to 300.20 ng/liter). Five (8.3%) of the positive raw cow's milk samples had AFM1 levels (153.52 +/- 100.60 ng/liter; range, 61.20 to 300.20 ng/liter) that were higher than the maximum tolerance limit (0.05 ppb) stipulated by regulations in Turkey and some other countries.

Maternal dietary habits and mycotoxin occurrence in human mature milk

During 2006, 82 samples of human mature milk were collected at Italian hospitals and checked for aflatoxin M1 (AFM1) and ochratoxin A (OTA) by immunoaffinity column extraction and HPLC. AFM1 was detected in four (5%) of milk samples (ranging from < 7 ng/L to 140 ng/L; mean level: 55.35 ng/L); OTA was detected in 61 (74%) of milk samples (ranging from < 5 ng/L to 405 ng/L; mean level: 30.43 ng/L. OTA levels were significantly higher (p less, not double equals 0.05) in milk of habitual consumers of bread, bakery products and cured pork meat. No other statistically significant differences were observed although habitual consumers of pasta (p = 0.059), cookies (p = 0.061) and juices (p = 0.063) had mean contamination values of OTA higher than the moderate consumer. The very few AFB1 positive samples did not allow statistical comparisons. The present study confirms that the occurrence of OTA in human milk is related to maternal dietary habits. The findings support the possibility of dietary recommendations to woman, during pregnancy and lactation, aimed to tentatively reduce the OTA contamination of human milk.