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Jacobson T, Bae Y, Kler JS, Iyer R, Zhang R, Montgomery ND, Nunes D, Pleil JD, Funk WE. Advancing Global Health Surveillance of Mycotoxin Exposures using Minimally Invasive Sampling Techniques: A State-of-the-Science Review. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024; 58:3580-3594. [PMID: 38354120 PMCID: PMC10903514 DOI: 10.1021/acs.est.3c04981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 02/16/2024]
Abstract
Mycotoxins are a heterogeneous group of toxins produced by fungi that can grow in staple crops (e.g., maize, cereals), resulting in health risks due to widespread exposure from human consumption and inhalation. Dried blood spot (DBS), dried serum spot (DSS), and volumetric tip microsampling (VTS) assays were developed and validated for several important mycotoxins. This review summarizes studies that have developed these assays to monitor mycotoxin exposures in human biological samples and highlights future directions to facilitate minimally invasive sampling techniques as global public health tools. A systematic search of PubMed (MEDLINE), Embase (Elsevier), and CINAHL (EBSCO) was conducted. Key assay performance metrics were extracted to provide a critical review of the available methods. This search identified 11 published reports related to measuring mycotoxins (ochratoxins, aflatoxins, and fumonisins) using DBS/DSS and VTS assays. Multimycotoxin assays adapted for DBS/DSS and VTS have undergone sufficient laboratory validation for applications in large-scale population health and human biomonitoring studies. Future work should expand the number of mycotoxins that can be measured in multimycotoxin assays, continue to improve multimycotoxin assay sensitivities of several biomarkers with low detection rates, and validate multimycotoxin assays across diverse populations with varying exposure levels. Validated low-cost and ultrasensitive minimally invasive sampling methods should be deployed in human biomonitoring and public health surveillance studies to guide policy interventions to reduce inequities in global mycotoxin exposures.
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Affiliation(s)
- Tyler
A. Jacobson
- Department
of Preventive Medicine, Northwestern University
Feinberg School of Medicine, Chicago, Illinois 60611, United States
| | - Yeunook Bae
- Department
of Preventive Medicine, Northwestern University
Feinberg School of Medicine, Chicago, Illinois 60611, United States
| | - Jasdeep S. Kler
- University
of Michigan Medical School, Ann Arbor, Michigan 48109, United States
| | - Ramsunder Iyer
- Department
of Preventive Medicine, Northwestern University
Feinberg School of Medicine, Chicago, Illinois 60611, United States
| | - Runze Zhang
- Department
of Preventive Medicine, Northwestern University
Feinberg School of Medicine, Chicago, Illinois 60611, United States
| | - Nathan D. Montgomery
- Department
of Preventive Medicine, Northwestern University
Feinberg School of Medicine, Chicago, Illinois 60611, United States
| | - Denise Nunes
- Galter
Health Sciences Library, Northwestern University
Feinberg School of Medicine, Chicago, Illinois 60611, United States
| | - Joachim D. Pleil
- Department
of Environmental Sciences and Engineering, Gillings School of Public
Health, University of North Carolina, Chapel Hill, North Carolina 27599, United States
| | - William E. Funk
- Department
of Preventive Medicine, Northwestern University
Feinberg School of Medicine, Chicago, Illinois 60611, United States
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Kassim N, Ngure F, Smith L, Turner PC, Stoltzfus R, Makule E, Makori N, Phillips E. Provision of low-aflatoxin local complementary porridge flour reduced urinary aflatoxin biomarker in children aged 6-18 months in rural Tanzania. MATERNAL & CHILD NUTRITION 2023:e13499. [PMID: 36891916 DOI: 10.1111/mcn.13499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/10/2023]
Abstract
Aflatoxins are toxic secondary metabolites of fungi that colonize staple food crops, such as maize and groundnut, frequently used in complementary feeding. In preparation for a large trial, this pilot study examined if provision of a low-aflatoxin infant porridge flour made from local maize and groundnuts reduced the prevalence of a urinary aflatoxin biomarker in infants. Thirty-six infants aged 6-18 months were included from four villages in Kongwa District, Tanzania. The study was conducted over 12 days with a three-day baseline period and a 10 days where low-AF porridge flour was provided. Porridge intake of infants was assessed using quantitative 24-h recalls by mothers. Household food ingredients used in infant porridge preparation and urine samples were collected on Days 1-3 (baseline) and 10-12 (follow-up). Aflatoxins were measured in household foods, and AFM1 was measured in urine. At baseline and follow-up, 78% and 97%, respectively, of the infants consumed porridge in the previous 24 h, with a median volume of 220 mL (interquartile range [IQR]: 201, 318) and 460 mL (IQR: 430, 563), respectively (p < 0.001). All 47 samples of homemade flour/ingredients were contaminated with AFs (0.3-723 ng/g). The overall prevalence of individuals with detectable urinary AFM1 was reduced by 81%, from 15/36 (42%) at baseline to 3/36 (8%) at follow-up (p = 0.003). Provision of low-aflatoxin porridge flour was acceptable to caregivers and their infants and successfully reduced the prevalence of detectable urinary AFM1 in infants, thus, confirming its potential to be tested in future large-scale health outcomes trial.
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Affiliation(s)
- Neema Kassim
- Department of Food Biotechnology and Nutritional Sciences, School of Life Science and Bio-Engineering, The Nelson Mandela African Institution of Science and Technology (NM-AIST), Arusha, Tanzania
| | | | - Laura Smith
- Department of Public & Ecosystem Health, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | - Paul C Turner
- MIAEH, School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Rebecca Stoltzfus
- Goshen College, Goshen, Indiana, USA.,Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Edna Makule
- Department of Food Biotechnology and Nutritional Sciences, School of Life Science and Bio-Engineering, The Nelson Mandela African Institution of Science and Technology (NM-AIST), Arusha, Tanzania
| | | | - Erica Phillips
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
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Benkerroum N, Ismail A. Human Breast Milk Contamination with Aflatoxins, Impact on Children's Health, and Possible Control Means: A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16792. [PMID: 36554670 PMCID: PMC9779431 DOI: 10.3390/ijerph192416792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
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.
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Affiliation(s)
- Noreddine Benkerroum
- Expertise Aliments Santé, Food Health Consultancy, 7450 Dollier Str., Montréal, QC H1S 2J6, Canada
| | - Amir Ismail
- Institute of Food Science and Nutrition, Bahauddin Zakariya University, Multan 60000, Pakistan
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Phillips E, Turner P, Ngure F, Kassim N, Makule E, Smith L, Nelson R, Stoltzfus R. Ethical considerations in the design and conduct of a cluster-randomised mycotoxin mitigation trial in Tanzania. WORLD MYCOTOXIN J 2022. [DOI: 10.3920/wmj2021.2705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Aflatoxins are fungal metabolites that commonly contaminate staple food crops in tropical regions. Acute aflatoxin consumption in very high concentration causes aflatoxicosis and acute liver failure, while chronic, moderate levels of intake cause hepatocellular carcinoma. The effects of frequent moderate- to high-level exposure during infancy, however, is less clearly understood. Half a billion people in low- and middle-income countries continue to be exposed to aflatoxins through dietary consumption, in part because of lack of enforcement of regulatory limits and few feasible long-term mitigation options in these settings. Several epidemiologic studies have shown an association between aflatoxin exposure in infants and young children and growth failure, but strong experimental evidence is lacking. The Mycotoxin Mitigation Trial conducted in Tanzania was a cluster-randomised trial to assess the effect of a reduced aflatoxin diet on linear growth. Prior to the design and implementation of this trial, a group of multi-disciplinary and multi-national scientists reviewed literature in biomedical, public health, environmental health ethics. In this paper we outline the most salient ethical questions and dilemmas in the potential conduct of such a study and describe the ethical precedents and principles that informed our decision-making processes and ultimate study protocol.
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Affiliation(s)
- E. Phillips
- Division of Nutritional Sciences, Cornell University, 244 Garden, Ithaca, NY 14853, USA
| | - P.C. Turner
- MIAEH, School of Public Health, University of Maryland, College Park, MD 20740, USA
| | - F.M. Ngure
- Independent Research Consultant, Arusha, Tanzania and Nairobi, Kenya
| | - N. Kassim
- Department of Food Biotechnology and Nutritional Sciences, (FBNS), School of Life Science and Bio-Engineering, The Nelson Mandela African Institution of Science and Technology (NM-AIST), P.O. Box 447, Arusha, Tanzania
| | - E. Makule
- Department of Food Biotechnology and Nutritional Sciences, (FBNS), School of Life Science and Bio-Engineering, The Nelson Mandela African Institution of Science and Technology (NM-AIST), P.O. Box 447, Arusha, Tanzania
| | - L.E. Smith
- Department of Population Medicine and Diagnostics, Cornell University, Ithaca, NY 14853, USA
| | - R.J. Nelson
- School of Integrative Plant Science and Department of Global Development, Cornell University, Ithaca, NY 14853, USA
| | - R.J. Stoltzfus
- Goshen College, 1700 S. Main Street, Goshen, Indiana 46526, USA
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Marín S, Ramos AJ, Sanchis V, Cano-Sancho G. An overview of mycotoxin biomarker application in exposome-health studies. Curr Opin Food Sci 2021. [DOI: 10.1016/j.cofs.2020.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Ismail A, Naeem I, Gong YY, Routledge MN, Akhtar S, Riaz M, Ramalho LNZ, de Oliveira CAF, Ismail Z. Early life exposure to dietary aflatoxins, health impact and control perspectives: A review. Trends Food Sci Technol 2021. [DOI: 10.1016/j.tifs.2021.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Development and Limitations of Exposure Biomarkers to Dietary Contaminants Mycotoxins. Toxins (Basel) 2021; 13:toxins13050314. [PMID: 33924868 PMCID: PMC8147022 DOI: 10.3390/toxins13050314] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 11/17/2022] Open
Abstract
Mycotoxins are toxic secondary fungal metabolites that frequently contaminate cereal crops globally, presenting exposure hazards to humans and livestock in many settings. The heterogeneous distribution of mycotoxins in food restricts the usefulness of food sampling and intake estimates for epidemiological studies, making validated exposure biomarkers better tools for informing epidemiological investigations. While biomarkers of exposure have served important roles for understanding the public health impact of mycotoxins such as aflatoxins (AF), the science of biomarkers must continue advancing to allow for better understanding of mycotoxins' roles in the etiology of disease and the effectiveness of mitigation strategies. This review will discuss mycotoxin biomarker development approaches over several decades for four toxins of significant public health concerns, AFs, fumonisins (FB), deoxynivalenol (DON), and ochratoxin A (OTA). This review will also highlight some knowledge gaps, key needs and potential pitfalls in mycotoxin biomarker interpretation.
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Alves DS, Assunção DT, Silva NCD, Oliveira CM, Amaral ABCN, Rinaldi AEM, Pena GDG. Nutritional Status and Growth Deficit in Children and Adolescents with Cancer at Different Moments of Treatment. Nutr Cancer 2020; 73:1668-1675. [PMID: 32838574 DOI: 10.1080/01635581.2020.1810714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Nutrition deficits are common in children and adolescents undergoing cancer treatment and can contribute to a worse prognosis. There are scarce studies regarding this context considering different moments of treatment. The aim of this study was to evaluate the association between moment of treatment and nutritional status in children and adolescents with cancer. METHODS A retrospective study was performed from January 2013 to December 2015, including data from all clinical records of patients under 18 years old with cancer. Clinical, nutritional support and anthropometric data were collected at four moments of treatment from cancer diagnosis: diagnosis (t0), 3 mo, (t1), 6 mo, (t2) and 1 year (t3). In addition, nutritional indicators were evaluated. Generalized Estimating Equation models were performed to analyze changes on anthropometric indices throughout four moments of treatment. RESULTS The sample comprised 73 patients and frequency of nutritional deficits ranged from 13.0% to 18.6%. All nutritional indicators decreased at t1, showed a modest recovery at t2 and a stronger recovery at t3 (p < 0.001). Growth was also impacted during treatment, mainly on patients under 2 years in the first three months of treatment. CONCLUSIONS Moment of treatment was associated with growth deficit and decreased percentiles in development indicators.
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Affiliation(s)
- Débora Santana Alves
- Graduate Program in Health Sciences, Federal University of Uberlandia, Uberlandia, Brazil
| | - Dayane Tonaco Assunção
- School of Medicine, Nutrition Course, Federal University of Uberlandia, Uberlandia, Brazil
| | | | - Cássia Maria Oliveira
- Food and Nutrition Service of Clinical Hospital, Federal University of Uberlandia, Uberlandia, Brazil
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