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Foerster C, Monsalve L, Ríos-Gajardo G. Infant exposure to ochratoxin A, zearalenone, and deoxynivalenol from the consumption of milk formula and baby cereal in Chile. Food Res Int 2024; 187:114389. [PMID: 38763651 DOI: 10.1016/j.foodres.2024.114389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 04/02/2024] [Accepted: 04/20/2024] [Indexed: 05/21/2024]
Abstract
Ochratoxin A (OTA), zearalenone (ZEN), and deoxynivalenol (DON) are mycotoxins whose exposure is associated with various adverse health effects, including cancer and renal disorders, estrogenic effects, and immunosuppressive and gastrointestinal disorders, respectively. Infants (<2 years) are the most vulnerable group to mycotoxins, representing a unique combination of restricted food consumption types, low body weight, lower ability to eliminate toxins, and more future years to accumulate toxins. This study aimed to estimate the infant́s exposure to OTA, DON, and ZEN due to the consumption of milk formula and baby cereals in Chile. Milk formula samples (n = 41) and baby cereals (n = 30) were collected and analyzed using commercial ELISA kits for OTA, DON, and ZEA determination. Exposure was assessed by the Estimated Daily Intake (EDI) approach (mean and worst-case scenario, WCS) with the levels found in a modified Lower Bound (mLB) and Upper Bound (UB); ideal consumption (<6m, 7-12 m, and 13-24 m); adjusted by the weight of each group. The risk was estimated by comparing the EDI with a reference tolerable daily intake or by the margin of exposure (MOE) in the case of OTA. DON and OTA occurrence in infant formula were 34 % and 41 %, respectively. The co-occurrence between these mycotoxins was 22 %. Mycotoxin contents were below LOQ values except for OTA determined in one sample (0.29 ng/ml). No milk formulae were contaminated with ZEN. In the case of baby cereals, the occurrences were 17 % for OTA, 30 % for DON, and 7 % for ZEN, all below LOQ. Co-occurrence was seen in two samples between ZEN and OTA. According to exposure calculations, the MOE for OTA was less than 10,000 in all models for milk formula between 0 to 12 months of age and in the UB and WCS for cereal consumption. Health concerns were observed for DON in the WCS and UB for milk consumption in all ages and only in the UB WCS for cereal consumption. Considering the high consumption of milk formula in these age groups, regulation of OTA and other co-occurring mycotoxins in infant milk and food is strongly suggested.
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Affiliation(s)
- Claudia Foerster
- Instituto de Ciencias Agroalimentarias, Animales y Ambientales (ICA3), Universidad de O'Higgins, San Fernando, Chile.
| | - Liliam Monsalve
- Instituto de Ciencias Agroalimentarias, Animales y Ambientales (ICA3), Universidad de O'Higgins, San Fernando, Chile
| | - Gisela Ríos-Gajardo
- Department of Food Science and Technology, Faculty of Pharmacy, University of Concepción, Concepción, Chile
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Kinkade CW, Aleksunes LM, Brinker A, Buckley B, Brunner J, Wang C, Miller RK, O'Connor TG, Rivera-Núñez Z, Barrett ES. Associations between mycoestrogen exposure and sex steroid hormone concentrations in maternal serum and cord blood in the UPSIDE pregnancy cohort. Int J Hyg Environ Health 2024; 260:114405. [PMID: 38878407 DOI: 10.1016/j.ijheh.2024.114405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/20/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024]
Abstract
Zearalenone (ZEN) is a fungal-derived toxin found in global food supplies including cereal grains and processed foods, impacting populations worldwide through diet. Because the chemical structure of ZEN and metabolites closely resembles 17β-estradiol (E2), they interact with estrogen receptors α/β earning their designation as 'mycoestrogens'. In animal models, gestational exposure to mycoestrogens disrupts estrogen activity and impairs fetal growth. Here, our objective was to evaluate relationships between mycoestrogen exposure and sex steroid hormone concentrations in maternal circulation and cord blood for the first time in humans. In each trimester, pregnant participants in the UPSIDE study (n = 297) provided urine for mycoestrogen analysis and serum for hormone analysis. At birth, placental mycoestrogens and cord steroids were measured. We fitted longitudinal models examining log-transformed mycoestrogen concentrations in relation to log-transformed hormones, adjusting for covariates. Secondarily, multivariable linear models examined associations at each time point (1st, 2nd, 3rd trimesters, delivery). We additionally considered effect modification by fetal sex. ZEN and its metabolite, α-zearalenol (α-ZOL), were detected in >93% and >75% of urine samples; >80% of placentas had detectable mycoestrogens. Longitudinal models from the full cohort exhibited few significant associations. In sex-stratified analyses, in pregnancies with male fetuses, estrone (E1) and free testosterone (fT) were inversely associated with ZEN (E1 %Δ: -6.68 95%CI: -12.34, -0.65; fT %Δ: -3.22 95%CI: -5.68, -0.70); while α-ZOL was positively associated with E2 (%Δ: 5.61 95%CI: -1.54, 9.85) in pregnancies with female fetuses. In analysis with cord hormones, urinary mycoestrogens were inversely associated with androstenedione (%Δ: 9.15 95%CI: 14.64, -3.30) in both sexes, and placental mycoestrogens were positively associated with cord fT (%Δ: 37.13, 95%CI: 4.86, 79.34) amongst male offspring. Findings support the hypothesis that mycoestrogens act as endocrine disruptors in humans, as in animal models and livestock. Additional work is needed to understand impacts on maternal and child health.
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Affiliation(s)
- Carolyn W Kinkade
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, USA.
| | - Lauren M Aleksunes
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, USA; Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA
| | - Anita Brinker
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, USA
| | - Brian Buckley
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, USA
| | - Jessica Brunner
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, USA
| | - Christina Wang
- Clinical and Translational Science Institute, The Lundquist Institute at Harbor - UCLA Medical Center, Torrance, CA, USA
| | - Richard K Miller
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, USA; Department of Environmental Medicine, Pediatrics and Pathology, University of Rochester, New York, NY, 14642, USA
| | - Thomas G O'Connor
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, USA; Department of Psychiatry, University of Rochester, NY, USA; Wynne Center for Family Research, University of Rochester, USA
| | - Zorimar Rivera-Núñez
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, USA; Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Emily S Barrett
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, USA; Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, USA; Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
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Ubong D, Stewart L, Sepai O, Knudsen LE, Berman T, Reynders H, Van Campenhout K, Katsonouri A, Van Nieuwenhuyse A, Ingelido AM, Castaño A, Pedraza-Díaz S, Eiríksdóttir ÁV, Thomsen C, Hartmann C, Gjorgjev D, De Felip E, Tolonen H, Santonen T, Klanova J, Norström K, Kononenko L, Silva MJ, Uhl M, Kolossa-Gehring M, Apel P, Jõemaa M, Jajcaj M, Estokova M, Luijten M, Lebret E, von Goetz N, Holcer NJ, Probst-Hensch N, Cavaleiro R, Barouki R, Tarroja E, Balčienė RM, Strumylaite L, Latvala S, Namorado S, Szigeti T, Ingi Halldorsson T, Olafsdottir K, Wasowicz W. Application of human biomonitoring data to support policy development, raise awareness and environmental public health protection among countries within the HBM4EU project. Int J Hyg Environ Health 2023; 251:114170. [PMID: 37207539 DOI: 10.1016/j.ijheh.2023.114170] [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: 07/17/2022] [Revised: 04/16/2023] [Accepted: 04/17/2023] [Indexed: 05/21/2023]
Abstract
Most countries have acknowledged the importance of assessing and quantifying their population's internal exposure from chemicals in air, water, soil, food and other consumer products due to the potential health and economic impact. Human biomonitoring (HBM) is a valuable tool which can be used to quantify such exposures and effects. Results from HBM studies can also contribute to improving public health by providing evidence of individuals' internal chemical exposure as well as data to understand the burden of disease and associated costs thereby stimulating the development and implementation of evidence-based policy. To have a holistic view on HBM data utilisation, a multi-case research approach was used to explore the use of HBM data to support national chemical regulations, protect public health and raise awareness among countries participating in the HBM4EU project. The Human Biomonitoring for Europe (HBM4EU) Initiative (https://www.hbm4eu.eu/) is a collaborative effort involving 30 countries, the European Environment Agency (EEA) and the European Commission (contracting authority) to harmonise procedures across Europe and advance research into the understanding of the health impacts of environmental chemical exposure. One of the aims of the project was to use HBM data to support evidence based chemical policy and make this information timely and directly available for policy makers and all partners. The main data source for this article was the narratives collected from 27 countries within the HBM4EU project. The countries (self-selection) were grouped into 3 categories in terms of HBM data usage either for public awareness, policy support or for the establishment HBM programme. Narratives were analysed/summarised using guidelines and templates that focused on ministries involved in or advocating for HBM; steps required to engage policy makers; barriers, drivers and opportunities in developing a HBM programme. The narratives reported the use of HBM data either for raising awareness or addressing environmental/public health issues and policy development. The ministries of Health and Environment were reported to be the most prominent entities advocating for HBM, the involvement of several authorities/institutions in the national hubs was also cited to create an avenue to interact, discuss and gain the attention of policy makers. Participating in European projects and the general population interest in HBM studies were seen as drivers and opportunities in developing HBM programmes. A key barrier that was cited by countries for establishing and sustaining national HBM programmes was funding which is mainly due to the high costs associated with the collection and chemical analysis of human samples. Although challenges and barriers still exist, most countries within Europe were already conversant with the benefits and opportunities of HBM. This article offers important insights into factors associated with the utilisation of HBM data for policy support and public awareness.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dragan Gjorgjev
- Institute of Public Health, Republic of North Macedonia, Macedonia
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Yan J, Kong L, Zhang X, Yu M, Zhu K, Zhao A, Shi D, Sun Y, Wang J, Shen W, Li L. Maternal Zearalenone Exposure Affects Gut Microbiota and Follicular Development in Suckled Offspring. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2022; 70:15570-15582. [PMID: 36514903 DOI: 10.1021/acs.jafc.2c06457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Zearalenone (ZEN) is a mycotoxin that is widely present in feed and agricultural products. Studies have demonstrated that ZEN, as a type of estrogen analogue, can significantly affect the female reproductive system. Breast milk is the best nutrient for infant growth and development, but it is still unknown whether ZEN influences the fertility of offspring through suckling. In this study, we collected fecal and ovarian tissue from neonatal female offspring, whose mothers were exposed to ZEN for 21 days, and explored the effects of maternal ZEN exposure on intestinal microecology and follicular development in the mouse using 16S rRNA amplicon sequencing technology. Our findings suggested that maternal ZEN exposure significantly diminished ovarian reserve, increased apoptosis of ovarian granulosa cell (GC), and impacted the developmental competence of oocytes in lactating offspring. In addition, the results of 16S rRNA sequencing showed that the abundance of gut microbiota in offspring was significantly changed, including Bacteroidetes, Proteobacteria, and Firmicutes. This leads to alterations of glutathione metabolism and the expression of antioxidant enzymes in ovaries. In summary, our findings supported a potential relationship between gut microbiota and abnormal ovarian development caused by ZEN, which offers novel insights for therapeutic strategies for reproductive disorders induced by ZEN exposure.
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Affiliation(s)
- Jiamao Yan
- College of Life Sciences, Qingdao Agricultural University, Qingdao 266109, China
| | - Li Kong
- College of Life Sciences, Qingdao Agricultural University, Qingdao 266109, China
- College of Life Sciences, Inner Mongolia University, Hohhot 010021, China
| | - Xiaoyuan Zhang
- College of Life Sciences, Qingdao Agricultural University, Qingdao 266109, China
| | - Mubin Yu
- College of Life Sciences, Qingdao Agricultural University, Qingdao 266109, China
| | - Kexin Zhu
- College of Life Sciences, Qingdao Agricultural University, Qingdao 266109, China
| | - Aihong Zhao
- Qingdao Academy of Agricultural Sciences, Qingdao 266100, China
| | - Dachuan Shi
- Qingdao Academy of Agricultural Sciences, Qingdao 266100, China
| | - Yonghong Sun
- Qingdao Academy of Agricultural Sciences, Qingdao 266100, China
| | - Junjie Wang
- College of Life Sciences, Qingdao Agricultural University, Qingdao 266109, China
| | - Wei Shen
- College of Life Sciences, Qingdao Agricultural University, Qingdao 266109, China
| | - Lan Li
- College of Life Sciences, Qingdao Agricultural University, Qingdao 266109, China
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Human Biomonitoring of Selected Hazardous Compounds in Portugal: Part II—Lessons Learned on Mycotoxins. Molecules 2021; 27:molecules27010130. [PMID: 35011364 PMCID: PMC8747060 DOI: 10.3390/molecules27010130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/20/2021] [Accepted: 12/23/2021] [Indexed: 11/17/2022] Open
Abstract
Human biomonitoring (HBM) data provide information on total exposure regardless of the route and sources of exposure. HBM studies have been applied to quantify human exposure to contaminants and environmental/occupational pollutants by means of determining the parent compounds, their metabolites, or even their reaction products in biological matrices. HBM studies performed among the Portuguese population are dispersed and limited. Thus, to overcome this knowledge gap, this work reviews the published Portuguese HBM information concerning mycotoxins detected in the urine, serum, milk, hair, and nails of different groups of the Portuguese population. This integrative approach to the available HBM data allows us to analyze the main determinants and patterns of exposure of the Portuguese population to the selected hazardous compounds, as well as to assess the potential health risks. We also aimed to identify the main difficulties and challenges of HBM through the analysis of the enrolled studies. Ultimately, this study aims to support national and European policies in promoting human health by summarizing the most important outcomes and lessons learned through the HBM studies carried out in Portugal.
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Kinkade CW, Rivera-Núñez Z, Gorcyzca L, Aleksunes LM, Barrett ES. Impact of Fusarium-Derived Mycoestrogens on Female Reproduction: A Systematic Review. Toxins (Basel) 2021; 13:toxins13060373. [PMID: 34073731 PMCID: PMC8225184 DOI: 10.3390/toxins13060373] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 01/03/2023] Open
Abstract
Contamination of the world’s food supply and animal feed with mycotoxins is a growing concern as global temperatures rise and promote the growth of fungus. Zearalenone (ZEN), an estrogenic mycotoxin produced by Fusarium fungi, is a common contaminant of cereal grains and has also been detected at lower levels in meat, milk, and spices. ZEN’s synthetic derivative, zeranol, is used as a growth promoter in United States (US) and Canadian beef production. Experimental research suggests that ZEN and zeranol disrupt the endocrine and reproductive systems, leading to infertility, polycystic ovarian syndrome-like phenotypes, pregnancy loss, and low birth weight. With widespread human dietary exposure and growing experimental evidence of endocrine-disrupting properties, a comprehensive review of the impact of ZEN, zeranol, and their metabolites on the female reproductive system is warranted. The objective of this systematic review was to summarize the in vitro, in vivo, and epidemiological literature and evaluate the potential impact of ZEN, zeranol, and their metabolites (commonly referred to as mycoestrogens) on female reproductive outcomes. We conducted a systematic review (PROSPERO registration CRD42020166469) of the literature (2000–2020) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The data sources were primary literature published in English obtained from searching PubMed, Web of Science, and Scopus. The ToxR tool was applied to assess risk of bias. In vitro and in vivo studies (n = 104) were identified and, overall, evidence consistently supported adverse effects of mycoestrogens on physiological processes, organs, and tissues associated with female reproduction. In non-pregnant animals, mycoestrogens alter follicular profiles in the ovary, disrupt estrus cycling, and increase myometrium thickness. Furthermore, during pregnancy, mycoestrogen exposure contributes to placental hemorrhage, stillbirth, and impaired fetal growth. No epidemiological studies fitting the inclusion criteria were identified.
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Affiliation(s)
- Carolyn W. Kinkade
- Joint Graduate Program in Exposure Science, Department of Environmental Sciences, Rutgers University, Piscataway, NJ 08854, USA
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ 08854, USA; (Z.R.-N.); (L.M.A.)
- Correspondence: (C.W.K.); (E.S.B.)
| | - Zorimar Rivera-Núñez
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ 08854, USA; (Z.R.-N.); (L.M.A.)
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ 08854, USA
| | - Ludwik Gorcyzca
- Joint Graduate Program in Toxicology, Rutgers University, Piscataway, NJ 08554, USA;
| | - Lauren M. Aleksunes
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ 08854, USA; (Z.R.-N.); (L.M.A.)
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ 08854, USA
- Rutgers Center for Lipid Research, New Jersey Institute for Food, Nutrition, and Health, Rutgers University, New Brunswick, NJ 08901, USA
| | - Emily S. Barrett
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ 08854, USA; (Z.R.-N.); (L.M.A.)
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ 08854, USA
- Correspondence: (C.W.K.); (E.S.B.)
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Tardieu D, Travel A, Le Bourhis C, Metayer JP, Mika A, Cleva D, Boissieu C, Guerre P. Fumonisins and zearalenone fed at low levels can persist several days in the liver of turkeys and broiler chickens after exposure to the contaminated diet was stopped. Food Chem Toxicol 2021; 148:111968. [PMID: 33422601 DOI: 10.1016/j.fct.2021.111968] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/10/2020] [Accepted: 12/30/2020] [Indexed: 01/23/2023]
Abstract
Previous studies using zearalenone (ZEN) and fumonisins (FB) revealed alpha-zearalanol (α-ZOL) and FB1 in the liver of turkeys and chickens with no sign of toxicity. The aim of the present study was to determine whether contamination persists after distribution of a mycotoxin-free diet for several days. Turkeys and broilers were fed for 14 days with a diet containing respectively, 7.5 and 0.6 mg/kg of FB and ZEN, then fed for 0, 2 or 4 days with a mycotoxin-free diet. FB1 and total α-ZOL were the most abundant metabolites found, and their concentration decreased with time. The decrease was linear for FB1 (P < 0.001) and exponential for α-ZOL. Mean concentrations of FB1 on days 0, 2, and 4 were respectively, 4.9, 4, and 2.9 ng/g in turkeys, and respectively, 5, 2.3, and 1.3 ng/g in chickens. The decrease in concentration of FB1 with time was modeled by linear regression (P < 0.001). Mean concentrations of α-ZOL on days 0, 2 and 4, were respectively, 4.8, 0.8, and 0.5 ng/g in turkeys, whereas α-ZOL was only quantified in chickens on day 0 at 0.3 ng/g. A strong correlation was found between α-ZOL and β-zearalenol (P < 0.001).
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Affiliation(s)
- D Tardieu
- Université de Toulouse, ENVT, F-31076, Toulouse, France
| | - A Travel
- ITAVI, L'Orfrasière, 37380, Nouzilly, France
| | - C Le Bourhis
- INRAE, Unité 1295 PEAT Centre Recherche Val de Loire, 37380, Nouzilly, France
| | - J-P Metayer
- ARVALIS-Institut du Végétal, Station expérimentale, 91720, Boigneville, France
| | - A Mika
- ITAVI, L'Orfrasière, 37380, Nouzilly, France
| | - D Cleva
- Chêne Vert Conseil, Z Bellevue II, Chateaubourg, France
| | - C Boissieu
- Chêne Vert Conseil, Z Bellevue II, Chateaubourg, France
| | - P Guerre
- Université de Toulouse, ENVT, F-31076, Toulouse, France.
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Ropejko K, Twarużek M. Zearalenone and Its Metabolites-General Overview, Occurrence, and Toxicity. Toxins (Basel) 2021; 13:35. [PMID: 33418872 PMCID: PMC7825134 DOI: 10.3390/toxins13010035] [Citation(s) in RCA: 122] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 12/29/2020] [Accepted: 01/01/2021] [Indexed: 12/27/2022] Open
Abstract
Mycotoxins are secondary metabolites of filamentous fungi and represent one of the most common groups of food contaminants with low molecular weight. These toxins are considered common and can affect the food chain at various stages of production, harvesting, storage and processing. Zearalenone is one of over 400 detected mycotoxins and produced by fungi of the genus Fusarium; it mainly has estrogenic effects on various organisms. Contaminated products can lead to huge economic losses and pose risks to animals and humans. In this review, we systemize information on zearalenone and its major metabolites.
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Affiliation(s)
| | - Magdalena Twarużek
- Department of Physiology and Toxicology, Faculty of Biological Sciences, Kazimierz Wielki University, Chodkiewicza 30, 85-064 Bydgoszcz, Poland;
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Assunção R, Viegas S. Mycotoxin Exposure and Related Diseases. Toxins (Basel) 2020; 12:toxins12030172. [PMID: 32168950 PMCID: PMC7150930 DOI: 10.3390/toxins12030172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 12/25/2022] Open
Affiliation(s)
- Ricardo Assunção
- Food and Nutrition Department, National Institute of Health Dr. Ricardo Jorge, Avenida Padre Cruz, 1649-016 Lisboa, Portugal
- CESAM, Centre for Environmental and Marine Studies, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
- Correspondence: (R.A.); (S.V.)
| | - Susana Viegas
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), 1150-090 Lisbon, Portugal
- H&TRC-Health & Technology Research Center, ESTeSL-Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, 1990-096 Lisbon, Portugal
- Correspondence: (R.A.); (S.V.)
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