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Hassen JY, Debella A, Eyeberu A, Mussa I. Prevalence and concentration of aflatoxin M 1 in breast milk in Africa: a meta-analysis and implication for the interface of agriculture and health. Sci Rep 2024; 14:16611. [PMID: 39025909 PMCID: PMC11258143 DOI: 10.1038/s41598-024-59534-1] [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: 09/20/2023] [Accepted: 04/11/2024] [Indexed: 07/20/2024] Open
Abstract
Breast milk is one of the many distinct forms of food that can be contaminated with aflatoxin M1 (AFM1). They may be consumed by eating contaminated foods, such as contaminated meat and crops, which would then be present in breast milk and cause health problems, including nervous system disorders and cancers of the lungs, liver, kidneys, and urinary tract. However, the prevalently inconsistent explanation of prevalence and concentration remains a big challenge. Thus, this meta-analysis was conducted to determine the prevalence and concentration of harmful chemicals in breast milk in an African context. The databases MEDLINE, PubMed, Embase, SCOPUS, Web of Science, and Google Scholar were searched for both published and unpublished research. To conduct the analysis, the collected data were exported to Stata version 18. The results were shown using a forest plot and a prevalence with a 95% confidence interval (CI) using the random-effects model. The Cochrane chi-square (I2) statistics were used to measure the studies' heterogeneity, and Egger's intercept was used to measure publication bias. This review included twenty-eight studies with 4016 breast milk samples and newborns. The analysis showed the overall prevalence and concentration of aflatoxin M1 in breast milk were 53% (95% CI 40, 65; i2 = 98.26%; P = 0.001). The pooled mean aflatoxin M1 concentration in breast milk was 93.02 ng/l. According to this study, the eastern region of Africa was 62% (95% CI 39-82) profoundly affected as compared to other regions of the continent. In subgroup analysis by publication year, the highest level of exposure to aflatoxins (68%; 95% CI 47-85) was observed among studies published from 2010 to 2019. This finding confirmed that more than half of lactating women's breast milk was contaminated with aflatoxin M1 in Africa. The pooled mean aflatoxin M1 concentration in breast milk was 93.02 ng/l. According to this study, the eastern region of Africa was profoundly affected compared with other regions. Thus, the government and all stakeholders must instigate policies that mitigate the toxicity of aflatoxins in lactating women, fetuses, and newborns.
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Affiliation(s)
- Jemal Y Hassen
- Department of Rural Development and Agricultural Extension, College of Agriculture and Environmental Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addis Eyeberu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Ibsa Mussa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
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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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Rezaei Z, Hamzeh Pour S, Ezati P, Akrami-Mohajeri F. Determination of aflatoxin M 1 and ochratoxin A in breast milk in rural centers of Yazd, Iran: Exposure assessment and risk characterization. Mycotoxin Res 2024; 40:211-221. [PMID: 38285127 DOI: 10.1007/s12550-024-00519-4] [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: 07/19/2023] [Revised: 12/29/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024]
Abstract
Breast milk (BM) is considered as the best source of nutrition which could have prevention effects on various diseases in the first years of a child. Along with nutritive compounds, presence of contaminants such as mycotoxins in BM could be transmitted into neonate. The aim of this study was to determine the occurrence, levels, and factors associated with the presence of aflatoxin M1 (AFM1) and ocratoxin a (OTA) in BM samples of nursing mothers in rural centers of Yazd, Iran. The presence and average AFM1 and OTA concentration in 72 BM samples was measured by competitive ELISA. The demographic and diet parameters of nursing mothers were collected by a questionnaire and were analyzed using SPSS 18 software. AFM1 and OTA were detected in 63 (87.5%) and 47 (65.2%) samples with the mean concentration levels of 19.46 ± 13.26 ng/L (ranges from 5.1 to 53.9) and 200 ± 160 ng/L (ranges from 100 to 2460), respectively. Of these, 32 samples (50.7%) for AFM1 and 23 samples (48.9%) for OTA had values exceeding the limit set by the European Union regulation for infant foods (25 ng/L for AFM1 and 500 ng/L for OTA). It was also found that the risk of AFM1 and OTA occurrence in BM increased significantly with the consumption of beans, bread, cereals, fruit juice and crackers, and cream, respectively. This study showed that the estimated daily intake for AFM1 and OTA by 1 month of age infants was 2.7 and 28.5 ng/kg bw/day, respectively, while, as the age of the infant increased, the values were lower and close to 0.9 and 9.9 ng/kg bw/day for AFM1 and OTA in 12 months of age infants, respectively. The high occurrence and noticeable levels of AFM1 and OTA detected in this study indicated that some infants receive undesirable exposures to AFM1 and OTA with breast milk. Therefore, it is recommended that mothers are advised to avoid certain foods during pregnancy and breastfeeding that are likely sources of mycotoxins.
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Affiliation(s)
- Zeinab Rezaei
- Center of Cheshme noshan khorasan (Alis), University of Applied Science and Technology, Chanaran, Iran
| | - Siavash Hamzeh Pour
- Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Parya Ezati
- BioNanocomposite Research Center, Department of Food and Nutrition, Kyung Hee University, 26 Kyungheedae‑Ro, Dongdaemun‑Gu, Seoul, 02447, Republic of Korea
| | - Fateme Akrami-Mohajeri
- Infectious Diseases Research Center, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
- Department of Food Hygiene and Safety, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Das Trisha A, Hafsa JM, Hasan A, Habib A, Tuba HR, Degen GH, Ali N. Occurrence of ochratoxin A in breast milk and urine samples of nursing mothers in Bangladesh. Mycotoxin Res 2024; 40:135-146. [PMID: 38038834 PMCID: PMC10834631 DOI: 10.1007/s12550-023-00510-5] [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: 09/19/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 12/02/2023]
Abstract
The mycotoxin ochratoxin A (OTA) is a potent nephrotoxin with carcinogenic properties and, thus, of concern as a food contaminant. Since food contaminant data are scarce in Bangladesh, we applied human biomonitoring to gain more insights into OTA exposure in the country's population. OTA concentrations in human milk and urine samples of nursing mothers were determined with the aim to assess also exposure to this mycotoxin in breastfed infants. Breastfeeding mothers (n = 74) from three districts of Bangladesh (Sylhet, Cumilla, and Mymensingh region) participated in this study. They provided demographic data, along with breast milk and urine samples. OTA levels were measured by a competitive enzyme-linked immunosorbent assay (ELISA) with a detection limit of 60 ng/L for milk and 30 ng/L for urine.OTA was detected in 62.2% of all breast milk samples (mean 74.8 ± 49.0 ng/L, range < LOD-243.3 ng/L) and in 51.4% of all urine samples (mean 44.3 ± 63.5 ng/L, range < LOD-519.3 ng/L). The differences observed between regions for mean breast milk or for urinary OTA levels were relatively small. No significant correlation was observed between OTA levels in breast milk and food consumption patterns among nursing mothers. Regarding infant exposure, the estimated average daily intake of OTA for all was 15.0 ng/kg bw/day (range 4.5-45 ng/kg bw/day). In 34.5% of these infants, their estimated daily OTA intake exceeded a preliminary TDI value set by EFSA (17 ng/kg bw/day). The mean OTA intake was slightly higher (16.2 ± 7.8 ng/kg bw/day) in 1-2 months babies than in older infants (< 2 to 12 months), although the difference was not significant. Presence of OTA in most milk and urine samples of nursing mothers documents their widespread dietary mycotoxin exposure. Although based on a relatively small number of participants, the present analysis indicates non-negligible exposure of some nursed infants in Bangladesh. Therefore, further biomonitoring studies and investigations on major sources of OTA in food commodities are encouraged.
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Affiliation(s)
- Aporajita Das Trisha
- Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet, 3114, Bangladesh
| | - Jaasia Momtahena Hafsa
- Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet, 3114, Bangladesh
| | - Akibul Hasan
- Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet, 3114, Bangladesh
| | - Ahsan Habib
- Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet, 3114, Bangladesh
| | - Humaira Rashid Tuba
- Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet, 3114, Bangladesh
| | - Gisela H Degen
- Leibniz-Research Centre for Working Environment and Human Factors (IfADo) at the TU Dortmund, Ardeystr. 67, D-44139, Dortmund, Germany.
| | - Nurshad Ali
- Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet, 3114, Bangladesh.
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Jin X, Perrella SL, Lai CT, Taylor NL, Geddes DT. Oestrogens and progesterone in human milk and their effects on infant health outcomes: A narrative review. Food Chem 2023; 424:136375. [PMID: 37209436 DOI: 10.1016/j.foodchem.2023.136375] [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: 02/10/2023] [Revised: 04/26/2023] [Accepted: 05/11/2023] [Indexed: 05/22/2023]
Abstract
Human milk (HM) is a complex biological system that contains a wide range of bioactive components including oestrogens and progesterone. Whilst maternal oestrogens and progesterone concentrations drop rapidly after birth, they remain detectable in HM across lactation. Phytoestrogens and mycoestrogens, which are produced by plants and fungi, are also present in HM and can interact with oestrogen receptors to interfere with normal hormone functions. Despite the potential impact of HM oestrogens and progesterone on the infant, limited research has addressed their impact on the growth and health of breastfed infants. Furthermore, it is important to comprehensively understand the factors that contribute to these hormone levels in HM, in order to establish effective intervention strategies. In this review, we have summarized the concentrations of naturally occurring oestrogens and progesterone in HM from both endogenous and exogenous sources and discussed both maternal factors impacting HM levels and relationships with infant growth.
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Affiliation(s)
- Xuehua Jin
- School of Molecular Sciences, The University of Western Australia, Crawley 6009, WA, Australia
| | - Sharon Lisa Perrella
- School of Molecular Sciences, The University of Western Australia, Crawley 6009, WA, Australia
| | - Ching Tat Lai
- School of Molecular Sciences, The University of Western Australia, Crawley 6009, WA, Australia
| | - Nicolas Lyndon Taylor
- School of Molecular Sciences, The University of Western Australia, Crawley 6009, WA, Australia
| | - Donna Tracy Geddes
- School of Molecular Sciences, The University of Western Australia, Crawley 6009, WA, Australia.
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Mesfin A, Lachat C, Gebreyesus SH, Roro M, Tesfamariam K, Belachew T, De Boevre M, De Saeger S. Mycotoxins Exposure of Lactating Women and Its Relationship with Dietary and Pre/Post-Harvest Practices in Rural Ethiopia. Toxins (Basel) 2023; 15:toxins15040285. [PMID: 37104223 PMCID: PMC10143280 DOI: 10.3390/toxins15040285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/27/2023] [Accepted: 04/11/2023] [Indexed: 04/28/2023] Open
Abstract
Mycotoxins can be transferred to breast milk during lactation. Hence, the presence of multiple mycotoxins (aflatoxins B1, B2, G1, G2, and M1, alpha and beta zearalanol, deoxynivalenol, fumonisins B1, B2, B3, and hydrolyzed B1, nivalenol, ochratoxin A, ochratoxin alpha, and zearalenone) in breast milk samples was assessed in our study. Furthermore, the relationship between total fumonisins and pre/post-harvest and the women's dietary practices was examined. Liquid chromatography coupled with tandem mass spectrometry was used to analyze the 16 mycotoxins. An adjusted censored regression model was fitted to identify predictors of mycotoxins, i.e., total fumonisins. We detected only fumonisin B2 (15% of the samples) and fumonisin B3 (9% of the samples) while fumonisin B1 and nivalenol were detected only in a single breast milk sample. No association between total fumonisins and pre/post-harvest and dietary practices was found (p < 0.05). The overall exposure to mycotoxins was low in the studied women, although fumonisins contamination was not negligible. Moreover, the recorded total fumonisins was not associated with any of the pre/post-harvest and dietary practices. Therefore, to better identify predictors of fumonisin contamination in breast milk, longitudinal studies with food samples in addition to breast milk samples and with larger sample sizes are needed for the future.
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Affiliation(s)
- Addisalem Mesfin
- Centre of Excellence in Mycotoxicology and Public Health, Faculty of Pharmaceutical Sciences, Ghent University, 9000 Ghent, Belgium
- Department of Nutrition and Dietetics, Faculty of Public Health, Jimma University, Jimma 1000, Ethiopia
- Department of Human Nutrition, College of Agriculture, Hawassa University, Hawassa 1000, Ethiopia
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium
- MYTOX-SOUTH® International Thematic Network, Ghent University, 9000 Ghent, Belgium
| | - Seifu Hagos Gebreyesus
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa 1000, Ethiopia
| | - Meselech Roro
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa 1000, Ethiopia
| | - Kokeb Tesfamariam
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium
- Department of Public Health, College of Medicine and Health Sciences, Ambo University, Ambo 1000, Ethiopia
| | - Tefera Belachew
- Department of Nutrition and Dietetics, Faculty of Public Health, Jimma University, Jimma 1000, Ethiopia
| | - Marthe De Boevre
- Centre of Excellence in Mycotoxicology and Public Health, Faculty of Pharmaceutical Sciences, Ghent University, 9000 Ghent, Belgium
- MYTOX-SOUTH® International Thematic Network, Ghent University, 9000 Ghent, Belgium
| | - Sarah De Saeger
- Centre of Excellence in Mycotoxicology and Public Health, Faculty of Pharmaceutical Sciences, Ghent University, 9000 Ghent, Belgium
- MYTOX-SOUTH® International Thematic Network, Ghent University, 9000 Ghent, Belgium
- Department of Biotechnology and Food Technology, Faculty of Science, University of Johannesburg, Doornfontein Campus, Gauteng 2028, South Africa
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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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