The Presence of Aflatoxin M1 in Milk and Milk Products in Bangladesh

Risk of exposure to aflatoxin M1 through consumption of cow's milk among children in Magadu, Morogoro

Aflatoxin M1 (AFM1) contamination of milk affects the general population with particular attention to children who frequently consume milk as part of complementary food. This study determined AFM1 contamination of cow's milk and estimated the health risk of dietary AFM1 through consumption of cow's milk among children (6 to 36 months) in the Magadu ward of Morogoro region in Tanzania. A total of 165 mother-baby pairs were recruited and interviewed on child feeding practices with a focus on feeding of cow's milk in the past 24 h. Alongside the interview, 100 raw cows' milk samples were collected from subsampled respondent households and were analyzed for AFM1 using enzyme-linked immunosorbent assay (ELISA). The results showed that about 35% of the surveyed children consumed cow's milk in the form of plain milk, incorporated in porridge and/or tea. The amount consumed varied from 62.5 to 500 mls with a median of 125 (125, 250) mls at a frequency of 1 to 2 times a day. All raw cows' milk (100%) samples (n = 100) were found contaminated with AFM1 at concentrations ranging from 0.052 to 9.310 µg/L and median of 2.076 µg/L (1.27, 2.48). All samples were contaminated by AFM1 at levels above the limits of 0.05 µg/L of raw milk set by the Tanzania Bureau of Standard and the European Union, while 97% exceeded 0.5 µg/L set by the US Food and Drug Administration. Exposure to AFM1 due to consumption of cow's milk ranged from 0.0024 to 0.077 µg/kg bw per day with a median of 0.019 (0.0016, 0.026) µg/kg bw per day, while the margin of exposure (MOE) ranged from 5.19 to 166.76 and median 20.68 (15.33, 25.40) implying high risk of public health concern. This study recommends that advocacy on consumption of cows' milk to combat undernutrition in children should consider a holistic approach that considers the milk's safety aspect.

Aflatoxins posing threat to food safety and security in Pakistan: Call for a one health approach

Aflatoxins are among the most important mycotoxins due to their widespread occurrence and adverse impacts on humans and animals. These toxins and/or their metabolites cannot be destroyed with cooking or boiling methods. Therefore, consumption of aflatoxin-contaminated food may lead to impaired growth, compromised immunity, stomach and liver cancer, and acute toxicity. These adverse effects along with food wastage might have detrimental consequences on a country's economy. Several studies from Pakistan reported a high prevalence of aflatoxins in food and feed commodities (Range; milk = 0.6-99.4%, cereals, and grains = 0.38-41%, animal feed = 31-100%). Notably, Pakistan reported very high figures of impaired child growth-stunted 40.2%, wasted 17.7% and underweight 28.9%-that could be associated with the higher aflatoxin prevalence in food items. Importantly, high aflatoxins prevalence, i.e. 100%, 69% and 60.5%, in children has been reported in Pakistan. Food and feed are more prone to aflatoxin contamination due to Pakistan's hot and humid climate; however, limited awareness, inadequate policy framework, and weak implementation mechanisms are the major obstacles to effective control. This review will discuss aflatoxins prevalence, associated risk factors, adverse health effects, required regulatory regime, and effective control strategies adopting the One Health approach to ensure food safety and security.

Review, meta-analysis and carcinogenic risk assessment of aflatoxin M1 in different types of milks in Iran

REVIEWS

Despite in recent decades, several studies on the concentration of aflatoxins M1(AFM1) in various milks have been studied, as we know, no systematic review, meta-analysis and carcinogenic risk assessment study was conducted in Iran till now.

OBJECTIVES

In this study, a systematic review was conducted to collect, meta-analysis and carcinogenic risk assessment of the quantitative data regarding the prevalence and concentration of AFM1 in several types of milk produced in Iran.

CONTENT

In our study, the concentration and prevalence of AFM1 in different types of milk (Raw, pasteurized, and UHT) from 113 original articles in Iran using searching the Web of Science, PubMed, Scopus, Science Direct and Google Scholar (in Persian and English) databases from 2002 to august 2021 were collected. The concentration of AFM1 was meta-analyzed using the random effect model (REM) based on type of milk (raw, pasteurized and UHT) subgroups and Monte Carlo simulation (MCS) approach was used to assess safety risks and investigate carcinogenic effects of AFM1 using Crystal-Ball software (Version 11.1.3, Oracle, Inc., USA).

SUMMARY AND OUTLOOK

The 113 original article (In English and Persian) were included in this review. Meta-analysis indicated lower and upper of AFM1 in subgroups of raw, pasteurized and UHT milk in Iran was 9, 720, 2.7, 230.2, 19.23, and 221.6 ng/kg respectively. The Point estimate for carcinogenic risk of AFM1 showed as result of age increasing, the carcinogenic risk of Aflatoxin M 1 decreases and concentration of Aflatoxin M1 (ng/liter), plays the most effective role in carcinogenic risk of AFM1.

CONCLUSION

The presence of AFM1 in milk and its products due to its high toxicity and carcinogenic properties is a public health concern that the results show that the risk of carcinogenesis is higher at younger ages (less than 20 years). As a result, there is a strong association between consumption of raw milk, pasteurized milk and UHT and the risk of cancer in children and adults in Iran.

The Occurrence and Health Risk Assessment of Aflatoxin M1 in Raw Cow Milk Collected from Tunisia during a Hot Lactating Season

Milk is a staple food that is essential for human nutrition because of its high nutrient content and health benefits. However, it is susceptible to being contaminated by Aflatoxin M1 (AFM1), which is a toxic metabolite of Aflatoxin B1 (AFB1) presented in cow feeds. This research investigated AFM1 in Tunisian raw cow milk samples. A total of 122 samples were collected at random from two different regions in 2022 (Beja and Mahdia). AFM1 was extracted from milk using the QuEChERS method, and contamination amounts were determined using liquid chromatography (HPLC) coupled with fluorescence detection (FD). Good recoveries were shown with intra-day and inter-day precisions of 97 and 103%, respectively, and detection and quantification levels of 0.003 and 0.01 µg/L, respectively. AFM1 was found in 97.54% of the samples, with amounts varying from values below the LOQ to 197.37 µg/L. Lower AFM1 was observed in Mahdia (mean: 39.37 µg/L), respectively. In positive samples, all AFM1 concentrations exceeded the EU maximum permitted level (0.050 µg/L) for AFM1 in milk. In Tunisia, a maximum permitted level for AFM1 in milk and milk products has not been established. The risk assessment of AFM1 was also determined. Briefly, the estimated intake amount of AFM1 by Tunisian adults through raw cow milk consumption was 0.032 µg/kg body weight/day. The Margin of Exposure (MOE) values obtained were lower than 10,000. According to the findings, controls as well as the establishment of regulations for AFM1 in milk are required in Tunisia.

A multiple lateral flow immunoassay based on AuNP for the detection of 5 chemical contaminants in milk

Melamine (MEL), enrofloxacin (ENR), sulfamethazine (SMZ), tetracycline (TC), and aflatoxin M₁ (AFM₁) are the main chemical contaminants in milk. It is necessary to detect these miscellaneous chemical contaminants in milk synchronously to ensure the safety of the milk. In this study, a multiple lateral flow immunoassay (LFIA) was developed for the detection of MEL, ENR, SMZ, TC, and AFM₁ in milk. Under optimal experimental conditions, the cutoff values were 25 ng/mL for MEL, 1 ng/mL for ENR, 2.5 ng/mL for SMZ, 2.5 ng/mL for TC, and 0.25 ng/mL for AFM₁ in milk samples. The limits of detection of LFIA were 0.173 ng/mL for MEL, 0.078 ng/mL for ENR, 0.059 ng/mL for SMZ, 0.082 ng/mL for TC, and 0.0064 ng/mL for AFM₁. The recovery rates of LFIA in milk were 83.2-104.4% for MEL, 76.5-127.3% for ENR, 96.8-113.5% for SMZ, 107.1-166.6% for TC, and 93.5-130.3% for AFM₁. The coefficients of variation were all less than 15%. As a whole, the developed multiple lateral flow immunoassay showed potential as a highly reliable and excellent tool for the rapid and sensitive screening of MEL, ENR, SMZ, TC, and AFM₁ in milk.

Incidence and Levels of Aflatoxin M1 in Artisanal and Manufactured Cheese in Pernambuco State, Brazil

Cheese is one of the most susceptible dairy foods to accumulating aflatoxins due to their high affinity to caseins. The consumption of cheese contaminated with high levels of aflatoxin M1 (AFM1) can be highly harmful to humans. The present work, based on high-performance liquid chromatography (HPLC), highlights the frequency and levels of AFM1 in coalho and mozzarella cheese samples (n = 28) from the main cheese-processing plants in Araripe Sertão and Agreste in the state of Pernambuco, Brazil. Of the evaluated cheeses, 14 samples were artisanal cheeses and the remaining 14 were industrial (manufactured) cheeses. All samples (100%) had detectable levels of AFM1, with concentrations ranging from 0.026 to 0.132 µg/kg. Higher levels (p < 0.05) of AFM1 were observed in artisanal mozzarella cheeses, but none of the cheese samples exceed the maximum permissible limits (MPLs) of 2.5 µg/kg established for AFM1 in cheese in Brazil and 0.25 µg/kg in the European countries by the European Union (EU). The high incidence of low levels of AFM1 found in the evaluated cheeses underscores the need for stringent control measures to prevent this mycotoxin in milk used for cheese production in the study area, with the aim of protecting public health and reducing significant economic losses for producers.

Exposure and Health Risk Assessment of Aflatoxin M1 in Raw Milk and Cottage Cheese in Adults in Ethiopia

Aflatoxin M₁ (milk toxin) found in milk is formed from the hepatic biotransformation of AFB₁ (aflatoxin B₁) and poses a risk to human health when consumed. The risk assessment of AFM₁ exposure due to milk consumption is a valuable way to assess health risk. The objective of the present work was to determine an exposure and risk assessment of AFM₁ in raw milk and cheese, and it is the first of its kind in Ethiopia. Determination of AFM₁ was conducted using an enzyme-linked immunosorbent assay (ELISA). The results indicated that AFM₁ was positive in all samples of milk products. The risk assessment was determined using margin of exposure (MOE), estimated daily intake (EDI), hazard index (HI), and cancer risk. The mean EDIs for raw milk and cheese consumers were 0.70 and 0.16 ng/kg bw/day, respectively. Our results showed that almost all mean MOE values were <10,000, which suggests a potential health issue. The mean HI values obtained were 3.50 and 0.79 for raw milk and cheese consumers, respectively, which indicates adverse health effects for large consumers of raw milk. For milk and cheese consumers, the mean cancer risk was 1.29 × 10^-6 and 2.9 × 10^-6 cases/100,000 person/year, respectively, which indicates a low risk for cancer. Therefore, a risk assessment of AFM₁ in children should be investigated further as they consume more milk than adults.

Assessment of aflatoxin M1 exposure and associated determinants in children from Lahore, Pakistan

Aflatoxins are potent carcinogenic and immunomodulatory mycotoxins, and exposure may lead to deleterious effects on human health. This study aimed to detect aflatoxin M₁ (AFM₁) as biomarker of exposure and determine associated risk factors in children attending a specialized-childcare hospital in Lahore. Urine samples collected from 238 children (1-11 years) during winter (January-mid-March 2020) and hot-humid summer (August-September 2020) were tested for AFM₁ presence using ELISA. Data on potential risk factors were also collected. Of 238 samples, 156 (65.5%) were positive for urinary AFM₁. Season was significantly associated (OR = 2.64; 95% CI = 1.49-4.79; p = 0.001) with AFM₁ positivity; prevalence was higher in hot-humid months (74.6%) than winter (57.3%). The place of living was also significantly associated (OR = 2.21; 95% CI = 1.25-3.97; p = 0.007), and urinary AFM₁ positivity was higher in urban children (71.1%) compared to rural (58.3%). Median value for creatinine-adjusted AFM₁ was 1.9 ng/mg creatinine (Q1-Q3 = 0.82-6.0 ng/mg creatinine), while non-creatinine-adjusted AFM₁ was 0.57 ng/mL (Q1-Q3 = 0.23-1.4 ng/mL). Significantly higher urinary AFM₁ levels were detected in children; age ≤2 years (p = 0.037), who consumed more milk (p = 0.048), and who presented to the nutrition clinic (p = 0.003). These findings highlight the need for an effective control program to reduce the AFM₁ burden in children.

Effects of aflatoxin B1 on human breast cancer (MCF-7) cells: cytotoxicity, oxidative damage, metabolic, and immune-modulatory transcriptomic changes

Aflatoxin B1 (AFB1) is a potent mycotoxin that is commonly produced by molds such as Aspergillus (A.) flavus and A. parasiticus. AFB1 is associated with several health adverse effects in humans including mutagenesis and carcinogenesis. Aflatoxin is commonly secreted in the milk leading to deleterious effects on breast tissue and potential nursing infants. However, the effects of aflatoxins, particularly AFB1, on the breast cells are less investigated. In this study, AFB1-associated effects on human breast cancer cell lines (MCF-7) were investigated. AFB1 caused significant cytotoxicity on MCF-7 cells. Such cytotoxicity had a positive correlation with the induction of oxidative stress. In addition, AFB1 caused significant transcriptomic alterations in xenobiotics and drug-metabolizing enzymes, transporters, and antioxidant enzymes. Besides, AFB1 upregulated pro-inflammatory markers such as tumor necrosis factor-α and cyclooxygenase-2 with a significant reduction of mRNA expressions of the immunity-related genes including interleukins 8 and 10.

Spore-based innovative paper-strip biosensor for the rapid detection of ß-lactam group in milk

The study's goal was to develop a spore-based paper strip biosensor for detecting ß-lactam antibiotics in milk using the enzyme induction principle. A new spore-based paper strip biosensor has been developed after important operating parameters such as spore volume, substrate volume, exposure time and temperature, and incubation time and temperature were optimised. The limit of detection for various ß-lactam antibiotics, including amoxicillin, penicillin, ampicillin, carbenicillin, cloxacillin, nafcillin, oxacillin, cephalothin, cefalexin, cefoxitin, cefazolin, and cefuroxime, was determined in milk with detection sensitivity of 1 ppb, 2 ppb, 2 ppb, 10 ppb, 10 ppb, 10 ppb, 20 ppb, 10 ppb 1000 ppb, 10 ppb 300 ppb and 100 ppb, respectively. It was also tested with other contaminants such non-ß-lactam antibiotics, pesticides, aflatoxin, heavy metals, and other chemical contaminants, and no interference was found, indicating that the created biosensor had a low rate of false positive and negative results. In comparison to the AOAC-approved CHARM-ROSA ß-lactam strip test, which identified 7 raw milk and zero pasteurised milk samples positive for ß-lactam antibiotics, the sensor was further analysed and verified using 200 raw milk and 105 pasteurised milk samples. This indicates a perfect match between our biosensor and the AOAC-approved CHARM-ROSA ß-lactam strip test. The developed spore-based paper strip biosensors are expected to be useful in the rapid and cost-effective detection of ß-lactam antibiotic residues in milk samples at the dairy farm, reception dock, and production units, respectively.

Occurrence of Aflatoxin M1 in Cow, Goat, Buffalo, Camel, and Yak Milk in China in 2016

In this present study, 195 cow milk, 100 goat milk, 50 buffalo milk, 50 camel milk, and 50 yak milk samples were collected in China in May and October 2016. The presence of aflatoxin M1 (AFM1) was determined using enzyme-linked immunosorbent assay method. For all cow milk samples, 128 samples (65.7%) contained AFM1 in concentrations ranging from 0.005 to 0.191 µg/L, and 6 samples (3.1%) from Sichuan province in October were contaminated with AFM1 above 0.05 µg/L (EU limit). For all goat milk samples, 76.0% of samples contained AFM1 in concentrations ranging from 0.005 to 0.135 µg/L, and 9 samples (9.0%) from Shanxi province in October were contaminated with AFM1 above 0.05 µg/L. For all buffalo milk samples, 24 samples (48.0%) contained AFM1 in concentrations ranging from 0.005 to 0.089 µg/L, and 2 samples collected in October were contaminated with AFM1 above 0.05 µg/L. Furthermore, 28.0% of samples contained AFM1 in concentrations ranging from 0.005 to 0.007 µg/L in camel milk samples, and 18.0% of samples contained AFM1 in concentrations ranging from 0.005 to 0.007 µg/L in yak milk samples. Our survey study has expanded the current knowledge of the occurrence of AFM1 in milk from five dairy species in China, in particular the minor dairy species.

Occurrence of Aflatoxin M1 in Milk and Dairy Products Traded in São Paulo, Brazil: An Update

The aim of this study was to conduct an up-to-date investigation on the occurrence levels of aflatoxin M1 (AFM1) in samples of raw milk (n = 40), pasteurized milk (n = 44), ultra-high temperature (UHT) milk (n = 27), Minas cheese (n = 57), and yogurt (n = 44) traded in São Paulo state, Brazil. AFM1 was extracted from fluid milks and dairy products using immunoaffinity columns and determined by high performance liquid chromatography. AFM1 was detected at the mean level of 0.080 ± 0.071 µg/L or kg in 72 samples (34.0%) evaluated in the study (n = 212). Detectable levels of AFM1 were observed in five samples of raw milk (12.5%), 16 samples of pasteurized milk (36.4%), 13 samples of UHT milk (48.1%), 27 samples of cheese (47.4%), and 11 samples of yogurt (25.0%), although none of them had concentrations above the maximum permitted levels (MPL) for AFM1 adopted in Brazil. However, 11.7% (n = 13) of samples of raw, pasteurized, and UHT milks would have AFM1 concentrations above the MPL of 0.05 μg/L adopted in the EU. The maximum level was detected in one cheese sample containing 0.695 µg/kg. Although none of the samples exceeded the Brazilian MPL, the high frequencies of AFM1 in Brazilian milk products warrant concern about their contribution to the human exposure to aflatoxins. Because aflatoxins are among the most potent carcinogens known, the results of this trial stress the need for stringent measures in the milk production system to avoid AFM1 in milk and derived products.

Assessment of multiple mycotoxin exposure and its association with food consumption: a human biomonitoring study in a pregnant cohort in rural Bangladesh

Aflatoxins (AFs), ochratoxin A (OTA), citrinin (CIT), fumonisin B1 (FB1), zearalenone (ZEN), and deoxynivalenol (DON) are mycotoxins that may contaminate diets, especially in low-income settings, with potentially severe health consequences. This study investigates the exposure of 439 pregnant women in rural Bangladesh to 35 mycotoxins and their corresponding health risks and links their exposure to certain foods and local stimulants. Overall, 447 first-morning urine samples were collected from pregnant women between July 2018 and November 2019. Mycotoxin biomarkers were quantified by DaS-HPLC-MS/MS. Urinary concentration of frequently occurring mycotoxins was used to estimate dietary mycotoxin exposure. Median regression analyses were performed to investigate the association between the consumption of certain foods and local stimulants, and urinary concentration of frequently occurring mycotoxins. Only in 17 of 447 urine samples (4%) were none of the investigated mycotoxins detected. Biomarkers for six major mycotoxins (AFs, CIT, DON, FB1, OTA, and ZEN) were detected in the urine samples. OTA (95%), CIT (61%), and DON (6%) were most frequently detected, with multiple mycotoxins co-occurring in 281/447 (63%) of urine samples. Under the lowest exposure scenario, dietary exposure to OTA, CIT, and DON was of public health concern in 95%, 16%, and 1% of the pregnant women, respectively. Consumption of specific foods and local stimulants-betel nut, betel leaf, and chewing tobacco-were associated with OTA, CIT, and DON urine levels. In conclusion, exposure to multiple mycotoxins during early pregnancy is widespread in this rural community and represents a potential health risk for mothers and their offspring.

Seasonal Occurrence of Aflatoxin M1 in Raw Milk during a Five-Year Period in Croatia: Dietary Exposure and Risk Assessment

This study’s objective was to estimate the seasonal occurrence of aflatoxin M₁ (AFM₁) in cow’s milk between winter 2016 and winter 2022 and to assess dietary exposure and risk assessment for the adult Croatian population. In total, 5817 cow milk samples were screened for AFM₁ concentrations using the enzyme immunoassay assay (ELISA). For confirmation purposes of AFM₁ concentration above the European Union maximum permitted level (MRL), ultra high-performance liquid chromatography with tandem mass spectrometry was performed. In 94.7% of milk samples, AFM₁ levels were below the detection limit (LOD) of the ELISA test. For 3.47% of samples, the AFM₁ was between the LOD and MRL values. Only 1.87% of all samples exceeded the MRL. The mean value of elevated AFM₁ in different seasons ranged between 59.2 ng/kg (autumn 2017) and 387.8 ng/kg (autumn 2021). The highest incidences of positive AFM₁ were determined in autumn and winter and the maximum (6.4%) was in winter 2019/2020. The largest percentage of positive samples (69.7%) was found in central Croatia. The estimated daily intakes for positive samples ranged between 0.17 and 2.82 ng/kg body weight/day. Risk assessment indicated a high level of concern during autumn and winter, especially for consumers of large amounts of milk.

Decrease in Aflatoxin M1 Concentration in Milk during Cholesterol Removal by Application of β-Cyclodextrin

Approximately one-third of humankind is chronically exposed to the carcinogenic aflatoxin M1 contained in milk. As β-cyclodextrin is frequently used in the food industry, its effect on aflatoxin M1 concentration was investigated during cholesterol removal from milk due to the similarity among the physicochemical properties of aflatoxin M1 and cholesterol. Moreover, the elimination of cholesterol using β-cyclodextrin has been successfully applied in many studies without any substantial effect on the quality of the treated milk. Therefore, milk samples were spiked with aflatoxin M1 within the range from 0.20 to 2.00 µg/kg, and cholesterol removal was carried out by 2.0% (w/w) β-cyclodextrin addition, as this concentration is enough for the sufficient removal of cholesterol. It was found that the mean cholesterol concentration decreased by 92.3%, while the aflatoxin M1 concentration decreased to 0.53 ± 0.04 µg/kg, i.e., by 39.1% after treatment (n = 2). This mitigation procedure itself is easy and inexpensive and thus is fully applicable with a high potential for complete decontamination of aflatoxin M1 milk. This method will therefore considerably improve the food safety issues associated with aflatoxin M1 presence in milk and dairy products.

Aflatoxin M1 in Raw Milk, Pasteurized Milk and Cottage Cheese Collected along Value Chain Actors from Three Regions of Ethiopia

Milk is a highly nutritious and perfect natural food for humans. However, when lactating animals feed on Aflatoxin B1 (AFB1)-containing feed, the hydroxyl metabolite aflatoxin M1 (AFM1) contaminates the milk and dairy products. The objective of the current study was to assess the level of AFM1 in raw milk, normally pasteurized milk and Ethiopian cottage cheese collected from value chain actors (producers, collectors, processors and retailers). Cross-sectional study and simple random techniques were used to collect primary samples. A total of 160 composite samples was collected; raw milk (n = 64), pasteurized milk (n = 64) and cheese (n = 32) was analyzed. Quantitative analysis of AFM1 was conducted using enzyme-linked immunosorbent assay (ELISA). The results indicate that AFM1 was detected in all milk products. Results along value chains show that the concentration of AFM1 in raw milk from collectors was significantly higher than from producers, and in pasteurized milk from processors and retailers (p < 0.05). However, no significant (p > 0.05) difference was observed in cottage cheese value-chain actors in all regions. Comparison of AFM1 mean values among all dairy products shows that raw milk had a significantly higher concentration of AFM1 followed by pasteurized milk and cottage cheese. However, there was no significant difference between raw and pasteurized milk (p > 0.05). The mean AFM1 contamination in milk products ranged from 0.137 to 0.319 µg/L (mean value 0.285 µg/L). The contamination percentages of AFM1 in raw milk (62.50%), pasteurized milk (67.20%) and cottage cheese (25%) were above the regulatory limit set by the European Union (EU) (0.05 µg/L). According to USA/Ethiopian Standard (US/ES) (0.50 µg/L), 21.87%, 25% and 1% exceeded the regulatory limit for the above products, respectively. The overall prevalence (56.88%) was above the EU regulatory limit and 19.38% over US/ES regulations. Therefore, to provide accurate information about the health risk to consumers, there is a need to conduct risk assessment studies in consumers of milk and dairy products at different age groups.