Aflatoxins and Heroin

Level of exposure to aflatoxins during pregnancy and its association with adverse birth outcomes in Africa: a meta-analysis

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Both published and unpublished studies in Africa were searched on MEDLINE, PubMed, Embase, SCOPUS, Web of Science and Google Scholar.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.

Presence of unreported carcinogens, Aflatoxins and their hydroxylated metabolites, in industrialized Oaxaca cheese from Mexico City

Aflatoxins (AFs) are toxic secondary metabolites of the fungi Aspergillus flavus, A. parasiticus and A. nomius. The fungi produce these AFs in cereals, oilseeds and spices. AFs have damaging effects on all organisms, including humans, and their symptoms can be classified as acute (vomiting, hemorrhage and death) or chronic (immunodepression, Reye syndrome, Kwashiorkor, teratogenesis, hepatitis, cirrhosis, and various cancers). Basic AFs (AFB₁, AFB₂, AFG₁, and AFG₂) are metabolized in the liver or by microbes that produce hydroxylated metabolites (AFM₁, AFM₂, and AFP₁) and aflatoxicol (AFL), soluble in water and easy to dispose. Thus, AFs can be excreted in fluids, such as milk. AFs are not destroyed in the process of making cheese. The purpose of this study was to identify and quantify the AFs present in 30 samples of industrialized Oaxaca-type cheese sold in Mexico City. The average concentrations of AFs detected in the 30 samples of industrialized cheese were as follows: AFB₁ (0.1 μg kg^-1) in 20% (6/30); a trace amount of AFB₂ (0.01 < LOD) in only 3% (1/30); AFG₁ (0.14 μg kg^-1) in 10% (3/30); AFG₂ (0.6 μg kg^-1) in 30% (9/30); AFM₁ (1.7 μg kg^-1) in 57% (17/30); AFP₁ (0.03% μg kg^-1) in 3% (1/30); and AFL (13.1 μg kg^-1) in 97% (29/30). AFB₁ and AFL were the most abundant aflatoxins in Oaxaca-type cheese. However, eight aflatoxins were present, contributing an average of 15.7 μg kg^-1 AFs distributed among the 30 samples. The risk assessment analysis showed that there was no substantial risk for cancer due to AFs in industrialized Oaxaca cheese from Mexico City.

Human aflatoxicosis in developing countries: a review of toxicology, exposure, potential health consequences, and interventions

Aflatoxins are well recognized as a cause of liver cancer, but they have additional important toxic effects. In farm and laboratory animals, chronic exposure to aflatoxins compromises immunity and interferes with protein metabolism and multiple micronutrients that are critical to health. These effects have not been widely studied in humans, but the available information indicates that at least some of the effects observed in animals also occur in humans. The prevalence and level of human exposure to aflatoxins on a global scale have been reviewed, and the resulting conclusion was that approximately 4.5 billion persons living in developing countries are chronically exposed to largely uncontrolled amounts of the toxin. A limited amount of information shows that, at least in those locations where it has been studied, the existing aflatoxin exposure results in changes in nutrition and immunity. The aflatoxin exposure and the toxic affects of aflatoxins on immunity and nutrition combine to negatively affect health factors (including HIV infection) that account for >40% of the burden of disease in developing countries where a short lifespan is prevalent. Food systems and economics render developed-country approaches to the management of aflatoxins impractical in developing-country settings, but the strategy of using food additives to protect farm animals from the toxin may also provide effective and economical new approaches to protecting human populations.