Aflatoxin Exposure During Pregnancy, Maternal Anemia, and Adverse Birth Outcomes

Effect of homemade peanut oil consumption during pregnancy on low birth weight and preterm birth outcomes: a cohort study in Southwestern China

BACKGROUND

Homemade peanut oil is widely consumed in rural areas of Southwestern China, which is easily contaminated by aflatoxins (AFs) and associated with adverse birth outcomes.

OBJECTIVE

To identify the effect of exposure to homemade peanut oil consumption on low birth weight (LBW), preterm birth (PB) and other associated factors.

METHODS

A prospective cohort study was conducted among pregnant women in Guangxi province, Southwestern China. Information of all eligible women on homemade peanut oil consumption and potential factors associated with LBW and PB was collected, and all were followed up until delivery. The effect of homemade peanut oil exposure was analyzed using multiple logistic regression models using the directed acyclic graph (DAG) approach.

RESULTS

Of 1611 pregnant women, 1316 (81.7%) had consumed homemade peanut oil, and the rates of LBW and PB were 9.7% and 10.0%, respectively. Increased risks of LBW and PB in women with homemade peanut oil consumption were found with aORs of 1.9 (95% CI 1.1-3.2) and 1.8 (95% CI 1.1-3.0), respectively. Women with a history of PB or LBW were 3-5 times more likely to have higher rates of LBW or PB compared with those without this type of history. The odds of PB were approximately double in those taking medicine during pregnancy. Advanced maternal age, lack of physical exercise during pregnancy, passive smoking, or pregnancy complications were also more likely to have a higher risk of LBW.

CONCLUSIONS

Homemade peanut oil consumption was a potential risk factor for both LBW and PB, of which health authorities who are responsible for food safety of the country should pay more attention to providing recommendation for oil consumption during pregnancy.

Dietary Aflatoxin G1 exposure causes an imbalance between pulmonary tissue-resident alveolar macrophages and monocyte-derived macrophages in both mother and offspring mice

Aflatoxin G1 (AFG1) is a mycotoxin commonly found in agricultural products, including dried fruits, meat, and milk products. Oral AFG1 administration induced tumor necrosis factor (TNF)-α-dependent chronic pulmonary inflammation, promoting AFG1-induced damage in alveolar epithelial cell, which is associated with lung adenocarcinoma. Pulmonary macrophages may be divided into tissue-resident alveolar macrophages (TRAMs) and monocyte-derived macrophages (MoMs), which involve in chronic lung inflammation. However, whether these macrophages contribute to AFG1-induced chronic pulmonary inflammation remains unknown. In this study, we found oral AFG1 administration disrupted the balance between TRAMs and MoMs, increasing MoMs infiltration and decreasing the number of TRAMs. AFG1 upregulated TNF-α expression in MoMs, but downregulated sialic acid binding Ig-like lectin F (Siglec-F) expression in TRAMs. Inhibition of TNF-α-dependent inflammation rescued the imbalance between TRAMs and MoMs in AFG1-treated lung tissues. Additionally, AFG1 stimulated MoMs differentiation to the proinflammatory M1 phenotype in vitro. Using a specific in vitro TRAM model, AFG1 downregulated Siglec-F and the M2 phenotypic markers arginase 1 and YM1, and upregulated the M1 phenotypic markers IL-6, iNOS and TNF-α, altering the TRAMs phenotype to the pro-inflammatory M1 phenotype in vitro. Additionally, mouse maternal dietary exposure to AFG1 caused an imbalance in pulmonary macrophages, decreasing TRAMs and increasing MoMs population in offspring, which was associated with proliferative lesions in the alveolar septa. Thus, dietary AFG1 exposure triggered an imbalance in pulmonary macrophages in both mother and offspring mice, and induced pro-inflammatory phenotypic alterations, which contributed to AFG1-induced chronic lung inflammation. These results provide clues to how AFG1-induced immunotoxicity and genotoxicity in humans might be prevented.

Assessment of Mycotoxin Exposure and Associated Risk in Pregnant Dutch Women: The Human Biomonitoring Approach

Mycotoxins are toxic secondary metabolites produced by various fungi that can contaminate food crops, which, in turn, may lead to human exposure. Chronic exposure to mycotoxins can cause adverse health effects including reproductive and developmental toxicity. Pregnant women and their foetuses present a vulnerable group for exposure to mycotoxins that can cross the placenta. Human biomonitoring of mycotoxins provides a real-life approach to estimate internal exposure. In this pilot study, 24-h urine samples from 36 pregnant Dutch women were analysed for aflatoxin M1 (AFM1), total deoxynivalenol (DON), de-epoxy-deoxynivalenol (DOM-1), total zearalenone (ZEN), total α-zearalenol (α-ZEL), total β-zearalenol (β-ZEL) and total zearalanone (ZAN), where 'total' refers to mycotoxins and their conjugated forms. Serum samples from these women were analysed for fumonisin B1 (FB1) and ochratoxin A (OTA). All samples were measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The most prevalent mycotoxins were total DON, total ZEN and OTA, with a detection frequency of 100%. DOM-1, total α-ZEL and total β-ZEL were detected but to a lesser extent, while AFM1, total ZAN and FB1 were undetected. Median concentrations were 4.75 μg total DON/L, 0.0350 μg DOM-1/L, 0.0413 μg total ZEN/L, 0.0379 μg total α-ZEL/L, 0.0189 μg total β-ZEL/L, and 0.121 μg OTA/L. The calculated median concentration for total ZEN and its metabolites was 0.105 μg/L. Based on two separate risk assessment approaches, total DON exposure in this group was considered to be of low concern. Similarly, exposure to total ZEN and its metabolites in this group was of low concern. For OTA, the risk of non-neoplastic effects was of low concern based on exposure in this group, and the risk of neoplastic effects was of low concern in the majority of participants in this group. The findings of this pilot study confirm the presence of mycotoxins in the urine and serum of pregnant Dutch women, with total DON, total ZEN, and OTA most frequently detected. Exposure to all measured mycotoxins was considered to be of low concern in this group, except for exposure to OTA, which was of low concern for the majority of participants. The study's findings offer valuable insights but should be confirmed using a larger and more diverse sample of the Dutch general population.

Association between low maternal serum aflatoxin B1 exposure and adverse pregnancy outcomes in Mombasa, Kenya, 2017-2019: A nested matched case-control study

We examined the association between serum aflatoxin B1-lysine adduct (AFB1-lys) levels in pregnant women and adverse pregnancy outcomes (low birthweight, miscarriage and stillbirth) through a nested matched case-control study of pregnant women enroled at ≤28 weeks' gestation in Mombasa, Kenya, from 2017 to 2019. Cases comprised women with an adverse birth outcome, defined as either delivery of a singleton infant weighing <2500 g, or a miscarriage, or a stillbirth, while controls were women who delivered a singleton live infant with a birthweight of ≥2500 g. Cases were matched to controls at a ratio of 1:2 based on maternal age at enrolment, gestational age at enrolment and study site. The primary exposure was serum AFB1-lys. The study included 125 cases and 250 controls. The median gestation age when serum samples were collected was 23.0 weeks (interquartile range [IQR]: 18.1-26.0) and 23.5 (IQR: 18.1-26.5) among cases and controls, respectively. Of the 375 tested sera, 145 (38.7%) had detectable serum AFB1-lys: 36.0% in cases and 40.0% in controls. AFB1-lys adduct levels were not associated with adverse birth outcomes on multivariable analysis. Mid-upper arm circumference was associated with a 6% lower odds of adverse birth outcome for every unit increase (p = 0.023). Two-fifths of pregnant women had detectable levels of aflatoxin midway through pregnancy. However, we did not detect an association with adverse pregnancy outcomes, likely because of low serum AFB1-lys levels and low power, restricting meaningful comparison. More research is needed to understand the public health risk of aflatoxin in pregnant women to unborn children.

AFB1 Toxicity in Human Food and Animal Feed Consumption: A Review of Experimental Treatments and Preventive Measures

AIMS

The current review aims to outline and summarize the latest research on aflatoxin, with research studies describing natural, herbal and chemical compound applications in animal (pig) models and in vitro cellular studies. Aflatoxin, a carcinogenic toxin metabolite, is produced by Aspergillus flavus in humid environments, posing a threat to human health and crop production. The current treatment involves the prevention of exposure to aflatoxin and counteracting its harmful toxic effects, enabling survival and research studies on an antidote for aflatoxin.

OBJECTIVES

To summarize current research prospects and to outline the influence of aflatoxin on animal forage in farm production, food and crop processing. The research application of remedies to treat aflatoxin is undergoing development to pinpoint biochemical pathways responsible for aflatoxin effects transmission and actions of treatment.

SIGNIFICANCE

To underline the environmental stress of aflatoxin on meat and dairy products; to describe clinical syndromes associated with aflatoxicosis on human health that are counteracted with proposed treatment and preventive interventions. To understand how to improve the health of farm animals with feed conditions.

Dietary aflatoxins exposure, environmental enteropathy, and their relation with childhood stunting

Childhood stunting is a global phenomenon affecting more than 149 million children under the age of 5 worldwide. Exposure to aflatoxins (AFs) in utero, during breastfeeding, and consumption of contaminated food affect the gut microbiome, resulting in intestinal dysfunction and potentially contributing to stunting. This review explores the potential relationship between AF exposure, environmental enteropathy and childhood stunting. AFs bind to DNA, disrupt protein synthesis and elicit environmental enteropathy (EE). An EE alters the structure of intestinal epithelial cells, impairs nutrient uptake and leads to malabsorption. This article proposes possible intervention strategies for researchers and policymakers to reduce AF exposure, EE and childhood stunting, such as exposure reduction, the implementation of good agricultural practices, dietary diversification and improving environmental water sanitation and hygiene.

First Results on the Presence of Mycotoxins in the Liver of Pregnant Fallow Deer (Dama dama) Hinds and Fetuses

Reproductive abnormalities have been observed in fallow deer populations in Hungary. We supposed mycotoxin contamination to be one of the possible causes because multi-mycotoxin contamination is known to be dangerous even at low toxin levels, especially for young animals. We investigated the spatial pattern of mycotoxin occurrences and the relationship between maternal and fetal mycotoxin levels. A total of 72 fallow deer embryos and their mothers were sampled in seven forested regions in Hungary in the 2020/2021 hunting season. We analyzed Aflatoxin (AF), Zearalenone (ZEA), Fumonizin B1 (FB1), DON, and T2-toxin concentrations in maternal and fetal livers by ELISA. AF was present in 70% and 82%, ZEA in 41% and 96%, DON in 90% and 98%, T2-toxin in 96% and 85%, and FB1 in 84% and 3% of hind and fetus livers, respectively. All mycotoxins passed into the fetus, but only Fumonizin B1 rarely passed. The individual variability of mycotoxin levels was extremely high, but the spatial differences were moderate. We could not prove a relation between the maternal and fetal mycotoxin concentrations, but we found an accumulation of ZEA and DON in the fetuses. These results reflect the possible threats of mycotoxins to the population dynamics and reproduction of wild fallow deer.

Correlations of Aflatoxin Exposure from Cooking Oil and Dietary Foods During Pregnancy with Birth Weight and Gestational Age at Birth in Guangxi, China

Background

Cooking oil and dietary foods are easily contaminated by aflatoxins (AFs) in Guangxi, China where low birth weight and preterm birth were prevalent. However, there are no data on AF exposure in pregnant women or their impact on newborn birth outcomes. This study aims to measure the levels and correlations of AFs in cooking oil, estimated dietary intake (EDI) of AFs in dietary foods, and serum AFB1 albumin adducts (AFB1-alb) with newborn birthweight and gestational age at birth.

Methods

A prospective study was conducted among 126 pregnant women in Guangxi, China. All recruited women were interviewed for demographic data and behavior and obstetric information and then followed up until giving birth. AF measurements were obtained from cooking oil, dietary foods, maternal serum, and cord blood and the correlations of AF levels with newborn birthweight and gestational age at birth were tested using correlation analysis.

Results

The median EDI of AFs in cooking oil was 2.61 ng/kg.bw/day and in dietary foods 2.95 ng/kg.bw/day. High positive correlations among EDI of aflatoxin B1 (AFB1) from cooking oil and dietary foods were found (r > 0.7). Low positive correlations of AFB1-alb in maternal serum and cord blood and both EDI of AFB1 in both cooking oil and dietary foods were shown (r ≈0.3). Significant correlations between AF levels in both cooking oil and dietary foods with birth weight were found, but very low negative correlations (r = - 0.244 ~ -0.285). AFB1 levels in foods, maternal serum and cord blood levels were high in pregnant women with newborn low birth weight and preterm birth.

Conclusion

The EDIs of AFB1 from both cooking oil and dietary foods were significantly correlated with AFB1-alb in maternal serum and cord blood. Negative correlations of AFs from cooking oils and foods with newborn birth weight should be paid more attention.

Evaluation of Aflatoxins Occurrence and Exposure in Cereal-Based Baby Foods: An Update Review

PURPOSE OF REVIEW

The first stages of human life, which include the fetal period, infancy, and early childhood, are the most critical for human growth and development. This is the most vulnerable phase to health challenges due to the immature immune system and rapid development. Mycotoxins such as aflatoxins, ochratoxin A, patulin, fumonisins, zearalenone, and deoxynivalenol are secondary metabolites secreted by various fungal species, primarily Aspergillus, Fusarium, Penicillium, and Alternaria. Aflatoxins are one of the major mycotoxins produced in cereals and cereal-based foods by several species of Aspergillus, mainly Aspergillus flavus. In this context, this review provides a brief overview of the occurrence, exposure, legal regulations, and health effects of aflatoxins (B1, B2, G1, G2, and M1) in cereal-based baby foods and breast milk.

RECENT FINDINGS

Human aflatoxin exposure in utero and through breast milk, infant formulas, cereals, and cereal-based foods has been linked to various health consequences, including adverse birth outcomes, impaired growth and development, immune system suppression, and hepatic dysfunction. Recent evidence suggests that especially infants and children are more susceptible to aflatoxins due to their lower body weight, lowered capacity to detoxify harmful substances, more restrictive diet, immature metabolism and elimination, and faster rates of growth and development. It is essential for both food safety and infant and child health that aflatoxins in cereal and cereal-based products are precisely detected, detoxified, and managed.

Assessment of dietary exposure and levels of mycotoxins in sorghum from Niger State of Nigeria

This study reports levels of mycotoxins in sorghum from Niger State, Nigeria, and provides a comprehensive assessment of their potential health risks by combining mycotoxin levels and dietary exposure assessment. A total of 240 samples of red and white sorghum were collected from both stores and markets across four microclimatic zones. Fungal species were identified using a dilution plate method. Aflatoxins (AFs), deoxynivalenol, nivalenol, and ochratoxin (OTA) were quantified using HPLC, whereas cyclopiazonic acid, fumonisins (FUMs) and zearalenone were quantified using ELISA. A. flavus and A. fumigatus were dominant fungal species followed by F. verticilloides, A. oryzae and P. verrucosum. Aflatoxins (mean: 29.97 µg/kg) were detected in all samples, whereas OTA (mean: 37.5 µg/kg) and FUMs (mean: 3269.8 µg/kg) were detected in 72% and 50% of the samples, respectively. Mycotoxins frequently co-occurred in binary mixtures of AFs + OTA and AFs + FUMs. Dietary exposure estimates were highest for FUMs at 230% of TDI and margin of exposures (MOEs) for both AFs and OTA (<10,000) indicating a potential risk associated with combined exposure to AFs and OTA. The Risk of hepatocellular carcinoma cases (HCC/year) attributable to AFs and OTA exposure from sorghum was estimated to be 5.99 × 105 and 0.24 × 105 cases for HBsAg + individuals based on 13.6% HBV incidence. Similarly, the HCC/year for AFs and OTA were assessed to be 3.59 × 105 and 0.14 × 105 at an 8.1% prevalence rate. Therefore, the results of this study demonstrate the high prevalence and dietary exposure to mycotoxins through sorghum consumption, raising public health and trade concerns.

Immunotoxicity and the mechanisms of aflatoxin B1-induced growth retardation in shrimp and alleviating effects of bile acids

Aflatoxin B1 (AFB1) is one of the most toxic mycotoxins prevalent in the environment and food chain, posing severe health risks to humans and animals. Bile acids are natural detergents synthesized from cholesterol and play a key role in the excretion of toxins in vertebrates. Here, pacific white shrimp (Litopenaeus vannamei) served as an animal model to examine the toxicity mechanisms of AFB1 and assess the potential alleviating effects of bile acids against AFB1. Our results revealed that AFB1 exposure significantly inhibited the growth performance and immune response of shrimp, accompanied by AFB1 accumulation and histological damage. Mechanistically, AFB1-induced DNA damage activated DNA repair mechanisms and induced the arrest of cell cycle via the ATR-cyclin B/cdc2 pathway. Additionally, AFB1 directly suppressed the immune response and growth performance of shrimp by inhibiting Toll and IMD pathways and the secretion of digestive enzymes. Notably, dietary bile acids significantly reduced AFB1 accumulation and alleviated AFB1-induced growth retardation and immunotoxicity in shrimp, and CCKAR, ATR, and Relish may be key mediators of the alleviating effects of bile acids. Our study provided new insights into the toxicity mechanisms of AFB1 in invertebrates and highlighted the potential of bile acids to alleviate AFB1 toxicity.

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.

Adverse associations between maternal deoxynivalenol exposure and birth outcomes: a prospective cohort study in China

BACKGROUND

Deoxynivalenol (DON), one of the most prevalent mycotoxins, has been found to cause fetal growth retardation in animals. However, limited evidence exists regarding its effects on pregnant women.

METHODS

Maternal urinary concentration of total DON (tDON) and free DON (fDON) in the second trimester was measured using liquid chromatography with tandem mass spectrometry. Provisional daily intake (PDI) of DON was calculated based on tDON concentration. Linear and logistic regression models were used to evaluate the association between DON exposure levels and birth weight, birth length, and the risk of small for gestational age (SGA).

RESULTS

Among 1538 subjects, the median concentrations of tDON and fDON were 12.1 ng/mL and 5.1 ng/mL, respectively. The PDI values revealed that the median DON intake was 0.7 µg/kg bw, and 35.9% of the total population exceeded the provisional maximum tolerable daily intake (PMTDI) of 1 µg/kg bw. Compared with the lowest tertile, birth weight decreased by 81.11 g (95% CI: -127.00, -35.23) for tDON (P-trend < 0.001) and 63.02 g (95% CI: -108.72, -17.32) for fDON (P-trend = 0.004) in the highest tertile. Each unit increase in Ln-tDON and Ln-fDON was also inversely associated with birth weight. Furthermore, compared to those who did not exceed PMTDI, pregnant women whose PDI exceeded PMTDI had lower birth weight (β = -79.79 g; 95% CI: -119.09, -40.49) and birth length (β = -0.21 cm; 95% CI: -0.34, -0.07), and a higher risk of SGA (OR = 1.48; 95% CI: 1.02, 2.15) in their offspring. Similar associations with birth weight, birth length, and SGA were found when comparing the highest tertile of PDI to the lowest tertile (all P-trend < 0.05).

CONCLUSIONS

Maternal DON exposure is related to decreased birth weight. Our findings implicate that DON exposure during pregnancy may cause fetal growth faltering, and measures should be taken to reduce DON exposure in pregnant women.

Endocrine Effect of Some Mycotoxins on Humans: A Clinical Review of the Ways to Mitigate the Action of Mycotoxins

Fungi such as Aspergillus spp. and Fusarium spp., which are commonly found in the environment, pose a serious global health problem. This study aims to present the results of epidemiological studies, including clinical cases, on the relationship between human exposure to some mycotoxins, especially zearalenone and aflatoxin, and the occurrence of reproductive disorders. In addition, examples of methods to reduce human exposure to mycotoxins are presented. In March 2023, various databases (PubMed, Google Scholar, EMBASE and Web of Science) were systematically searched using Google Chrome to identify studies evaluating the association between exposure to mycotoxins and the occurrence of complications related to impaired fertility or cancer incidence. The analysed data indicate that exposure to the evaluated mycotoxins is widespread and correlates strongly with precocious puberty, reduced fertility and increased cancer incidence in women and men worldwide. There is evidence to suggest that exposure to the Aspergillus mycotoxin aflatoxin (AF) during pregnancy can impair intrauterine foetal growth, promote neonatal jaundice and cause perinatal death and preterm birth. In contrast, exposure to the Fusarium mycotoxin zearalenone (ZEA) leads to precocious sexual development, infertility, the development of malformations and the development of breast cancer. Unfortunately, the development of methods (biological, chemical or physical) to completely eliminate exposure to mycotoxins has limited practical application. The threat to human health from mycotoxins is real and further research is needed to improve our knowledge and specific public health interventions.

Research Progress Related to Aflatoxin Contamination and Prevention and Control of Soils

Aflatoxins are potent carcinogenic compounds, mainly produced by fungi species of the genus Aspergillus in the soil. Because of their stability, they are difficult to remove completely, even under extreme conditions. Aflatoxin contamination is one of the main causes of safety in peanuts, maize, wheat and other agricultural products. Aflatoxin contamination originates from the soil. Through the investigation of soil properties and soil microbial distribution, the sources of aflatoxin are identified, aflatoxin contamination is classified and analysed, and post-harvest crop detoxification and corresponding contamination prevention measures are identified. This includes the team's recent development of the biofungicide ARC-BBBE (Aflatoxin Rhizobia Couple-B. amyloliquefaciens, B. laterosporu, B. mucilaginosus, E. ludwiggi) for field application and nanomaterials for post-production detoxification of cereals and oilseed crops, providing an effective and feasible approach for the prevention and control of aflatoxin contamination. Finally, it is hoped that effective preventive and control measures can be applied to a large number of cereal and oilseed crops.

Child Aflatoxin Exposure is Associated with Poor Child Growth Outcomes: A Prospective Cohort Study in Rural Malawi

Background

Aflatoxin (AF) exposure is associated with child growth faltering in cross-sectional studies, with limited findings from longitudinal studies.

Objectives

To evaluate the relationship between maternal AF B₁-lysine adduct concentration, child AF B₁-lysine adduct concentration, and child growth in the first 30 mo of life.

Methods

AF B₁-lysine adduct was measured in mother-child dyad plasma samples using isotope dilution mass spectrometry. Using linear regression, we assessed the relationship between AF B₁-lysine adduct concentration and child weight, height, and head and mid-upper arm circumferences at 1 wk, 6, 12, 18, 24, and 30 mo of age.

Results

In adjusted models, maternal prenatal AF B₁-lysine adduct (pg/μL) was positively associated with newborn anthropometric outcomes; largest beta coefficients for associations between standardized values were for newborn weight-for-age z-score [β = 0.13; 95% confidence interval (CI): 0.02, 0.24; P < 0.05 and β = 0.11; 95% CI: 0.00, 0.22; P < 0.05 for second and third trimester AF, respectively]. Child AF B₁-lysine adduct (pg/μL) at 6 mo was negatively associated with head circumference-for-age z-score at 6, 18, 24, and 30 mo, with beta coefficients ranging from β = -0.15; 95% CI: -0.28, -0.02 to β = -0.17; 95% CI: -0.31, -0.03; P < 0.05); 18-mo AF was negatively associated with anthropometric outcomes at 18, 24, and 30 mo, most consistently with length-for-age z-score (β = -0.18; 95% CI: -0.32, -0.04, β = -0.21; 95% CI: -0.35, -0.07, β = -0.18; 95% CI: -0.32, -0.03 at 18, 24 and 30 mo, respectively).

Conclusions

Child AF exposure was associated with impaired child growth, but maternal AF exposure was not. Exposure during infancy was linked to persistent deficit in head circumference, implying reduced brain size lasting beyond the age of 2 years. Exposure at 18 mo was linked to persistent linear growth deficit. Further research should elucidate mechanisms through which AF affects child growth.

Aflatoxin B1 exposure induced developmental toxicity and inhibited muscle development in zebrafish embryos and larvae

The prevalence of aflatoxin B1 (AFB1), one of the most toxic mycotoxins that contaminates feedstock and food is increasing worldwide. AFB1 can cause various health problems in humans and animals, as well as direct embryotoxicity. However, the direct toxicity of AFB1 on embryonic development, especially foetal foetus muscle development, has not been studied in depth. In the present study, we used zebrafish embryos as a model to study the mechanism of the direct toxicity of AFB1 to the foetus, including muscle development and developmental toxicity. Our results showed that AFB1 caused motor dysfunction in zebrafish embryos. In addition, AFB1 induces abnormalities in muscle tissue architecture, which in turn causes abnormal muscle development in larvae. Further studies found that AFB1 destroyed the antioxidant capacity and tight junction complexes (TJs), causing apoptosis in zebrafish larvae. In summary, AFB1 may induce developmental toxicity and inhibit muscle development through oxidative damage, apoptosis and disruption of TJs in zebrafish larvae. Our results revealed the direct toxicity effects of AFB1 on the development of embryos and larvae, including inhibition of muscle development and triggering neurotoxicity, induction of oxidative damage, apoptosis and disruption of TJs, and fills the gap in the toxicity mechanism of AFB1 on foetal development.

The effect of iron supplementation on maternal iron deficiency anemia does not differ by baseline anemia type among Tanzanian pregnant women without severe iron deficiency anemia

PURPOSE

Whether anemia type modifies the risk of pregnancy and newborn outcomes and the effectiveness of iron supplementation is unclear. We examined the association of iron deficiency anemia (IDA) and non-iron deficiency anemia (NIDA) on the risks of these outcomes and the extent to which anemia type modifies the impact of prenatal iron supplementation.

METHODS

This was a secondary analysis of a placebo-controlled trial of iron supplementation among 1450 HIV-negative women in Tanzania. Eligibility criteria included gestational age < 27 weeks, hemoglobin > 85 g/L, and ferritin > 12 µg/L. Individuals were categorized as non-anemia, IDA or NIDA using hemoglobin, ferritin and CRP. Analyses were conducted using regression models and likelihood ratio tests.

RESULTS

Compared to the non-anemia group, delivery hemoglobin was lower by 15 g/L (95% CI 10.9, 19.3) in the baseline IDA group, and 7.3 g/L (95% CI 3.1, 11.5) in the baseline NIDA group. The RRs of anemia severity, iron deficiency, placental malaria, stillbirths, perinatal mortality, birthweight, and preterm birth were not different among women in the baseline NIDA group (vs. non-anemia) compared to the baseline IDA group (vs. non-anemia). The difference in the mean delivery hemoglobin for iron supplementation and placebo arms was 8 g/L (95% CI 6, 11) in the non-anemia group, 7 g/L (95% CI 2, 13) in the NIDA group, and 16 g/L (95% CI 10, 22) in the IDA group.

CONCLUSION

Iron supplementation is effective even among pregnant women with NIDA.

TRIAL REGISTRATION

NCT01119612 (May 7, 2010).

Human Breast Milk Contamination with Aflatoxins, Impact on Children's Health, and Possible Control Means: A Review

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.

Congenital aflatoxicosis, mal-detoxification genomics & ontogeny trigger immune-mediated Kotb disease biliary atresia variant: SANRA compliant review

Biliary atresia (BA) is the most common indication for pediatric liver transplantation. We describe The BA variant: Kotb disease. Liver tissue in the Kotb disease BA is massively damaged by congenital aflatoxicosis resulting in inflammation, adhesions, fibrosis, bile duct proliferation, scarring, cholestasis, focal syncytial giant cell transformation, and typical immune response involving infiltration by CD4+, CD8+, CD68+, CD14+, neutrophil infiltration, neutrophil elastase spill, heavy loads of aflatoxin B1, accelerated cirrhosis, disruption of p53 and GSTPi, and have null glutathione S transferase M1 (GSTM1). All their mothers are heterozygous for GSTM1. This inability to detoxify aflatoxicosis results in progressive inflammatory adhesions and obliterative cholangiopathy early in life. The typical disruption of both p53 and GSTPi causes loss of fidelity of hepatic regeneration. Hence, regeneration in Kotb disease BA typically promotes accelerated cirrhosis. The immune response in Kotb disease BA is for damage control and initiation of regeneration, yet, this friendly fire incurs massive structural collateral damage. The Kotb disease BA is about actual ongoing hepatic entrapment of aflatoxins with lack of ability of safe disposal due to child detoxification-genomics disarray. The Kotb disease BA is a product of the interaction of persistent congenital aflatoxicosis, genetic lack of GSTM1 detoxification, ontogenically impaired activity of other hepatic detoxification, massive neutrophil-elastase, immune-induced damage, and disturbed regeneration. Ante-natal and neonatal screening for aflatoxicosis, avoiding cord milking, and stringent control of aflatoxicosis content of human, poultry and live-stock feeds might prove effective for prevention, prompt diagnosis and management based on our recent understanding of its patho-genomics.

earlyMYCO: A Pilot Mother-Child Cohort Study to Assess Early-Life Exposure to Mycotoxins—Challenges and Lessons Learned

Early-life exposure occurs during gestation through transfer to the fetus and later, during lactation. Recent monitoring data revealed that the Portuguese population is exposed to mycotoxins, including young children. This study aimed to develop a pilot study to assess the early-life exposure to mycotoxins through a mother–child cohort, and to identify the associated challenges. Participants were recruited during pregnancy (1st trimester) and followed-up in three moments of observation: 2nd trimester of pregnancy (mother), and 1st and 6th month of the child’s life (mother and child), with the collection of biological samples and sociodemographic and food consumption data. The earlyMYCO pilot study enrolled 19 mother–child pairs. The analysis of biological samples from participants revealed the presence of 4 out of 15 and 5 out of 18 mycotoxins’ biomarkers of exposure in urine and breast milk samples, respectively. The main aspects identified as contributors for the successful development of the cohort were the multidisciplinary and dedicated team members in healthcare units, reduced burden of participation, and the availability of healthcare units for the implementation of the fieldwork. Challenges faced, lessons learned, and suggestions were discussed as a contribution for the development of further studies in this area.

Apigeninidin-rich Sorghum bicolor (L. Moench) extracts suppress A549 cells proliferation and ameliorate toxicity of aflatoxin B1-mediated liver and kidney derangement in rats

Sorghum bicolor plant has a high abundance of 3-deoxyanthocyanins, flavonoids and other polyphenol compounds that have been shown to offer numerous health benefits. Epidemiological studies have linked increased intake of S. bicolor to reduced risk of certain cancer types, including lung adenocarcinoma. S. bicolor extracts have shown beneficial effects in managing hepatorenal injuries. This study investigated the cytotoxic potential of three apigeninidin-rich extracts of S. bicolor (SBE-05, SBE-06 and SBE-07) against selected cancer cell lines and their ameliorative effect on aflatoxin B₁ (AFB₁)-mediated hepatorenal derangements in rats. We observed that, among the three potent extracts, SBE-06 more potently and selectively suppressed the growth of lung adenocarcinoma cell line (A549) (IC₅₀ = 6.5 μg/mL). SBE-06 suppressed the expression of STAT3 but increased the expression of caspase 3. In addition, SBE-05, SBE-06 and SBE-07 inhibited oxidative and nitrosative stress, inflammation, and apoptosis and preserved the histoarchitectural networks of the liver and kidney of rats treated with AFB₁. These in vitro and in vivo studies indicate the potential of these cheap and readily accessible extracts for cancer therapy and as chemo-preventive agents in preventing aflatoxin-related health issues.

The mediating role of coagulation function on the association of prenatal exposure to aflatoxin B1 and postpartum hemorrhage in Guangxi, China

Pregnant women are vulnerable to certain environmental agents, one of which is aflatoxin. As one of the most popular aflatoxins, Aflatoxin B1 (AFB1) has recently garnered increased attention concerning its potential association between exposure and adverse pregnancy outcomes. The aims of the study were to examine the associations between prenatal exposure to AFB1 and postpartum hemorrhage (PPH), and whether coagulation function has a mediating effect on their relationship. A total of 379 mother-infant pairs were included in the present study. Prenatal serum AFB1 albumin (AFB1-Alb) adduct levels in peripheral venous blood were detected by using an ELISA kit. Multiple linear and logistics regression models were applied to analyze the relationship between AFB1-Alb levels and PPH. We found mothers with high levels of AFB1-Alb adduct levels had significantly increased postpartum blood loss (partial regression coefficient (β) = 50.71, 95% confidence interval (CI) 3.48, 97.95). Mothers with high levels of AFB1-Alb adduct levels also had significantly increased risk of PPH (odds ratio (OR) = 4.81, 95% CI 1.01, 22.98). Moreover, concentrations of AFB1-Alb were positively associated with activated partial thromboplastin time (APTT) while negatively associated with fibrinogen (FIB). One-unit increase in APTT was correlated with a 6.62-ml (95% CI 3.04, 10.20) increase in postpartum blood loss. Mediation analysis suggested that the maternal blood APTT levels had a positive mediating effect in the association between AFB1-Alb adduct levels and postpartum blood loss (β = 0.32, 95% CI 0.04, 0.68). These results indicated that prenatal exposure to AFB1 was associated with increased postpartum blood loss, possibly by interfering with maternal APTT levels.

Exposure to multiple mycotoxins, environmental enteric dysfunction and child growth: Results from the AflaCohort Study in Banke, Nepal

Evidence of the impact of exposure to multiple mycotoxins and environment enteric dysfunction (EED) on child growth is limited. Using data from a birth cohort study, the objectives of this study were to (a) quantify exposure to multiple mycotoxins (serum aflatoxin [AFB₁] and ochratoxin A [OTA], urinary fumonisin [UFB₁] and deoxynivalenol [DON]), as well EED (lactulose:mannitol [L:M] ratio); (b) examine the potential combined effects of multiple mycotoxin exposure and EED on growth. Multivariate regressions were used to identify associations between growth measurements (length, weight, anthropometric z‐scores, stunting and underweight) at 24–26 months of age and exposure to mycotoxins and EED at 18–22 months (n = 699). Prevalence of AFB₁, DON, OTA and UFB₁ exposure ranged from 85% to 100%; average L:M ratio was 0.29 ± 0.53. In individual mycotoxin models, AFB₁ exposure was negatively associated with weight, WAZ, increased odds of stunting (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 1.08, 1.52; p = 0.004) and underweight (OR: 1.18, 95% CI: 1.00, 1.38; p = 0.046). Irrespective of other mycotoxin exposure and presence of EED, AFB₁ was negatively associated with length, weight, head circumference, LAZ and WAZ, and with increased odds of stunting and underweight, UFB₁ was associated with increased odds of underweight, and DON was negatively associated with head circumference. EED was associated with the impaired length and weight. These findings suggest that certain mycotoxins and EED may have independent impacts on different facets of growth and that aflatoxin dominates such impacts. Thus, programs reducing exposure to mycotoxin and EED through multi‐sectoral nutrition‐sensitive interventions have the potential to improve child growth.

Mycotoxin exposure was highly prevalent in children aged 18–22 months. Various mycotoxins and EED contribute independently to different manifestations of poor child growth

AFB1 was negatively associated with length, weight, head circumference, LAZ, as well as WAZ, and associated with increased odds of stunting and underweight. UFB1 was also associated with increased odds of underweight. DON was negatively associated with head circumference.

Estimation of Tolerable Daily Intake (TDI) for Immunological Effects of Aflatoxin

Aflatoxins are toxic chemicals produced by the fungi Aspergillus flavus and Aspergillus parasiticus. In warm climates, these fungi frequently contaminate crops such as maize, peanuts, tree nuts, and sunflower seeds. In many tropical and subtropical regions of the world, populations are coexposed to dietary aflatoxin and multiple infectious pathogens in food, water, and the environment. There is increasing evidence that aflatoxin compromises the immune system, which could increase infectious disease risk in vulnerable populations. Our aim was to conduct a dose-response assessment on a noncarcinogenic endpoint of aflatoxin: immunotoxicological effects. We sought to determine a noncarcinogenic tolerable daily intake (TDI) of aflatoxin, based on the existing data surrounding aflatoxin and biomarkers of immune suppression. To conduct the dose response assessment, mammalian studies were assessed for appropriateness of doses (relevant to potential human exposures) as well as goodness of data, and two appropriate mouse studies that examined decreases in leukocyte counts were selected to generate dose response curves. From these, we determined benchmark dose lower confidence limits (BMDL) as points of departure to estimate a range of TDIs for aflatoxin-related immune impairment: 0.017-0.082 μg/kg bw/day. As aflatoxin is a genotoxic carcinogen, and regulations concerning its presence in food have largely focused on its carcinogenic effects, international risk assessment bodies such as the Joint Expert Committee on Food Additives (JECFA) have never established a TDI for aflatoxin. Our work highlights the importance of the noncarcinogenic effects of aflatoxin that may have broader public health impacts, to inform regulatory standard-setting.

Longitudinal Assessment of Prenatal, Perinatal, and Early-Life Aflatoxin B1 Exposure in 828 Mother-Child Dyads from Bangladesh and Malawi

BACKGROUND

In utero or early-life exposure to aflatoxin, which contaminates staple crops in disadvantaged settings, may compromise pregnancy and infant outcomes, but investigations into the extent, persistence, and determinants of aflatoxin exposure at these life stages have lacked longitudinal data collection and broad geographic representation.

OBJECTIVES

Aflatoxin exposure and selected determinants thereof were characterized in mother-child dyads with serial plasma/serum samples in prenatal, perinatal, and early life in Malawi and Bangladesh.

METHODS

Circulating aflatoxin B1 (AFB1)-lysine albumin adducts were measured in dyads from Bangladesh (n = 573; maternal first and third trimester, 3 mo postpartum, cord blood, infant 24 mo) and Malawi (n = 255; maternal second and third trimester, 6 mo postpartum, infant 6 and 18 mo) with isotope dilution mass spectrometry. We examined AFB1-lysine adduct magnitude, persistence, seasonality, and associations with infant feeding, and estimated daily AFB1 intake.

RESULTS

Maternal AFB1-lysine was higher in Malawi (98% detectable; median: 0.469, IQR: 0.225-1.027 pg/µL) than in Bangladesh (59%; 0.030, nondetectable [nd]-0.077 pg/µL). Although estimated dietary exposure in Malawi was temporally stable (648 ng AFB1/day), estimated intake in Bangladesh was reduced by 94% between rainy and winter seasons (98 to 6 ng/day). AFB1-lysine was low in cord blood from Bangladesh (15% detectable; 0.045, 0.031-0.088 pg/µL among detectable) and in Malawian infants at 6 mo of age (0.072, nd-0.236 pg/µL), but reached maternal concentrations by 18 or 24 mo (Bangladesh: 0.034, nd-0.063 pg/µL; Malawi: 0.370, 0.195-0.964 pg/µL). In Malawian infants, exclusive breastfeeding at 3 mo was associated with 58% lower AFB1-lysine concentrations at 6 mo compared with other feeding modes (P = 0.010).

CONCLUSIONS

Among pregnant women, aflatoxin exposure was persistently high in Malawi, while lower and seasonal in Bangladesh. Infants were partially protected from exposure in utero and with exclusive breastfeeding, but exposures reached adult levels by 18-24 mo of age. The Bangladesh and Malawi trials are registered at clinicaltrials.gov as NCT00860470 and NCT01239693.

Aflatoxin B1 targeted gene expression profiles in human placental primary trophoblast cells

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Gene expression profiles were studied in human primary trophoblast cells.

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170 genes were significantly dysregulated in aflatoxin B1-exposed trophoblasts.

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AhR-mediated estrogen receptor signalling was dysregulated in response to AFB1.

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Transcripts involved in endocrine signalling and energy homeostasis were disrupted.

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Cellular growth and development, cell cycle and DNA repair processes were affected.

Aflatoxin B1 (AFB1) is a mycotoxin produced by Aspergillus flavus and A. parasiticus. A high exposure (40 nM and 1 µM AFB1 for 72 h) was used to study mechanistic effects of AFB1 on gene expression patterns in human primary trophoblast cells, isolated from full term placentae after delivery. Gene expression profiling was conducted, and Ingenuity pathway analysis (IPA) software was used to identify AFB1-regulated gene networks and regulatory pathways.

In response to 40 nM AFB1, only 7 genes were differentially expressed whereas 1 µM AFB1 significantly dysregulated 170 genes (124 down- and 46 upregulated, ±1.5-fold, p < 0.05) in AFB1-exposed trophoblasts when compared to controls. The top downregulated genes were involved in endocrine signalling and biosynthesis of hormones, and lipid and carbohydrate metabolism. The top upregulated genes were involved in protein synthesis and regulation of cell cycle. The main canonical pathways identified by IPA were associated with endocrine signalling including growth hormone signalling, and corticotropin releasing hormone signalling. Furthermore, genes involved in aryl hydrocarbon receptor (AhR)-mediated estrogen receptor signalling were dysregulated in response to AFB1.

Our findings indicate that a high concentration 72 h AFB1 exposure caused relatively moderate number of changes on transcript level to human placental primary trophoblast cells. However, these preliminary results need to be confirmed with human-relevant concentrations of AFB1.

Effects of Prenatal Exposure to Aflatoxin B1: A Review

Aflatoxins are mycotoxins produced as secondary fungal metabolites. Among them, aflatoxin B1 (AFB1) stands out due to its genotoxic and mutagenic potential, being a potent initiator of carcinogenesis. In this review, the outcomes from the published literature in the past 10 years on the effects of AFB1 pathophysiological mechanisms on embryological and fetal development are discussed. In several animal species, including humans, AFB1 has a teratogenic effect_, resulting in bone malformations, visceral anomalies, lesions in several organs, and behavioral and reproductive changes, in addition to low birth weight. The mutagenic capacity of AFB1 in prenatal life is greater than in adults, indicating that when exposure occurs in the womb, the risk of the development of neoplasms is higher. Studies conducted in humans indicate that the exposure to this mycotoxin during pregnancy is associated with low birth weight, decreased head circumference, and DNA hypermethylation. However, as the actual impacts on humans are still unclear, the importance of this issue cannot be overemphasized and studies on the matter are essential.

Associations between Serum Aflatoxin-B1 and Anemia in Pregnant Women: Evidence from Guangxi Zhuang Birth Cohort in China

Aflatoxin B1 (AFB1) is a common toxic mycotoxin and is detectable in pregnant women. Animal studies have revealed that AFB1 caused the lysis of erythrocytes and a decrease in hemoglobin. We conducted a prospective cohort study in Guangxi, China, in order to evaluate the association between AFB1 exposure and anemia in pregnant women during the entire pregnancy. A total of 616 pregnant women from the Guangxi Zhuang Birth Cohort were included in the study. Serum AFB1-albumin (AFB1-ALB) adduct levels were measured. The effect of AFB1-ALB adducts on hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) were analyzed by using multivariable linear regression. The risks of anemia from AFB1-ALB adduct exposure were assessed by multivariable logistic regression. We found that the AFB1-ALB adduct was significantly associated with a decrease in Hb (β = -4.99, 95% CI: -8.42, -1.30), MCV (β = -4.58, 95% CI: -7.23, -1.94), MCH (β = -1.86, 95% CI: -2.87, -0.85), and MCHC (β = -5.23, 95% CI: -8.28, -2.17) in the first trimester with the third tertile of AFB1-ALB adducts when compared with the first tertile. Furthermore, the third tertile of the AFB1-ALB adduct significantly increased the risk of anemia by 2.90 times than compared to the first tertile in the first trimester (OR = 3.90, 95% CI: 1.67, 9.14). A significant positive does-response relationship existed between AFB1-ALB adduct levels and anemia risk (Ptrend = 0.001). When dividing anemia types, we only found that the third tertile of AFB1-ALB adduct increased the risk of microcytic hypochromic anemia (MHA) in the first trimester (OR = 14.37, 95% CI: 3.08, 67.02) and second trimester (OR = 4.75, 95% CI: 1.96, 11.51). These findings demonstrate the correlation between maternal AFB1 exposure during early pregnancy and risk of anemia, especially MHA, and during different trimesters in Southern China. More efforts should be made to diminish AFB1 exposure for pregnant women.

Aflatoxin Exposure during Early Life Is Associated with Differential DNA Methylation in Two-Year-Old Gambian Children

Background: DNA methylation is an epigenetic control mechanism that may be altered by environmental exposures. We have previously reported that in utero exposure to the mycotoxin and liver carcinogen aflatoxin B1 from the maternal diet, as measured using biomarkers in the mothers' blood, was associated with differential DNA methylation in white blood cells of 6-month-old infants from The Gambia. Methods: Here we examined aflatoxin B1-associated differential DNA methylation in white blood cells of 24-month-old children from the same population (n = 244), in relation to the child's dietary exposure assessed using aflatoxin albumin biomarkers in blood samples collected at 6, 12 and 18 months of age. HM450 BeadChip arrays were used to assess DNA methylation, with data compared to aflatoxin albumin adduct levels using two approaches; a continuous model comparing aflatoxin adducts measured in samples collected at 18 months to DNA methylation at 24 months, and a categorical time-dose model that took into account aflatoxin adduct levels at 6, 12 and 18 months, for comparison to DNA methylation at 24 months. Results: Geometric mean (95% confidence intervals) for aflatoxin albumin levels were 3.78 (3.29, 4.34) at 6 months, 25.1 (21.67, 29.13) at 12 months and 49.48 (43.34, 56.49) at 18 months of age. A number of differentially methylated CpG positions and regions were associated with aflatoxin exposure, some of which affected gene expression. Pathway analysis highlighted effects on genes involved with with inflammatory, signalling and growth pathways. Conclusions: This study provides further evidence that exposure to aflatoxin in early childhood may impact on DNA methylation.

Embryonic exposure to low concentrations of aflatoxin B1 triggers global transcriptomic changes, defective yolk lipid mobilization, abnormal gastrointestinal tract development and inflammation in zebrafish

Aflatoxin B1-contaminated feeds and foods induce various health problems in domesticated animals and humans, including tumor development and hepatotoxicity. Aflatoxin B1 also has embryotoxic effects in different livestock species and humans. However, it is difficult to distinguish between the indirect, maternally-mediated toxic effects and the direct embryotoxicity of aflatoxin B1 in mammals. In the present study, we investigated the aflatoxin B1-induced direct embryotoxic effects in a zebrafish embryo model system combining toxicological, transcriptomic, immunological, and biochemical approaches. Embryonic exposure to aflatoxin B1 induced significant changes at the transcriptome level resulting in elevated expression of inflammatory gene network and repression of lipid metabolism and gastrointestinal tract development-related gene sets. According to the gene expression changes, massive neutrophil granulocyte influx, elevated nitric oxide production, and yolk lipid accumulation were observed in the abdominal region of aflatoxin B1-exposed larvae. In parallel, aflatoxin B1-induced defective gastrointestinal tract development and reduced L-arginine level were found in our model system. Our results revealed the complex direct embryotoxic effects of aflatoxin B1, including inhibited lipid utilization, defective intestinal development, and inflammation.

Aflatoxin Biosynthesis, Genetic Regulation, Toxicity, and Control Strategies: A Review

Aflatoxins (AFs) are highly toxic and cancer-causing compounds, predominantly synthesized by the Aspergillus species. AFs biosynthesis is a lengthy process that requires as minimum as 30 genes grouped inside 75 kilobytes (kB) of gene clusters, which are regulated by specific transcription factors, including aflR, aflS, and some general transcription factors. This paper summarizes the status of research on characterizing structural and regulatory genes associated with AF production and their roles in aflatoxigenic fungi, particularly Aspergillus flavus and A. parasiticus, and enhances the current understanding of AFs that adversely affect humans and animals with a great emphasis on toxicity and preventive methods.

Aflatoxin B1 interferes with embryonic liver development: Involvement of p53 signaling and apoptosis in zebrafish

Aflatoxin B₁ (AFB₁), a naturally occurring mycotoxin, is present in human placenta and cord blood. AFB₁ at concentrations found in contaminated food commodities (0.25 and 0.5 μM) did not alter the spontaneous movement, heart rate, hatchability, or morphology of embryonic zebrafish. However, around 86 % of 0.25 μM AFB₁-treated embryos had livers of reduced size, and AFB₁ disrupted the hepatocyte structures, according to histological analysis. Additionally, AFB₁ treatment that begins at any stage before 72 h post-fertilization (hpf) effectively reduced the size of embryonic livers. In hepatic areas, AFB₁ suppressed the expression of Hhex and Prox1, which are two critical transcriptional factors for initiating hepatoblast specification. KEGG analysis based on transcriptome profiling indicated that p53 signaling and apoptosis are the only observed pathways in AFB₁-treated embryos. AFB₁ at 0.5 μM significantly activated the expression of tp53, mdm2, puma, noxa, pidd1, and gadd45aa genes that are related to the p53 pathway and also that of baxa, casp 8 and casp 3a in the apoptotic process. TUNEL staining demonstrated that AFB₁ triggered the apoptosis of embryonic hepatocytes in a dose-dependent manner. These results indicate that the deficiency of both hhex and prox1 as well as hepatocyte apoptosis via the p53-Puma/Noxa-Bax axis may contribute to the embryonic liver shrinkage that is caused by AFB_1.

Occurrence of aflatoxin M1 in human breast milk in Bangladesh

Breast milk is the best, most complete form of nutrition for newborns and infants. However, human milk can contain aflatoxin M₁ (AFM₁) upon ingestion of dietary mycotoxin contaminants, namely, aflatoxin B₁ (AFB₁), by lactating mothers. AFB₁ and its hydroxylated metabolite AFM₁ are potent carcinogens and thus an important issue in food safety and public health. This study is the first to explore the presence of AFM₁ in breast milk samples from Bangladesh and assess infant exposure to this toxin, as a consequence of maternal mycotoxin intake. A total of 62 breast milk samples were collected from nursing mothers in Sylhet region of Bangladesh. The milk samples were collected between October 2019 and March 2020 and analyzed by a sensitive enzyme-linked immunosorbent assay. AFM₁ was detected in 51.6% of the breast milk samples (colostrum, transitional and mature milk), with a mean concentration of 4.42 ± 0.56 pg/mL, and in the range between LOD (4.0 pg/mL) and 6.66 pg/mL. The frequent detection of AFM₁ in breast milk indicates widespread dietary exposure to mycotoxins in our cohort. The estimated average daily intake of AFM₁ for all nursed infants was 0.49 ng/kg b.w./day. No significant correlations were observed between AFM₁ levels in human milk and food items regularly consumed by nursing women. Overall, AFM₁ levels in breast milk samples from the Sylhet region of Bangladesh are moderate, and lower than the permissible levels established for AFM₁ in dairy milk or infant formulae (50 and 25 ng/kg, respectively). Yet, this first data for AFM₁ breast milk contaminant levels just reflect the recent situation in one cohort, and monitoring should be continued.

Exposure to toxic metals and per- and polyfluoroalkyl substances and the risk of preeclampsia and preterm birth in the United States: a review

Preeclampsia and preterm birth are among the most common pregnancy complications and are the leading causes of maternal and fetal morbidity and mortality in the United States. Adverse pregnancy outcomes are multifactorial in nature and increasing evidence suggests that the pathophysiology behind preterm birth and preeclampsia may be similar-specifically, both of these disorders may involve abnormalities in placental vasculature. A growing body of literature supports that exposure to environmental contaminants in the air, water, soil, and consumer and household products serves as a key factor influencing the development of adverse pregnancy outcomes. In pregnant women, toxic metals have been detected in urine, peripheral blood, nail clippings, and amniotic fluid. The placenta serves as a "gatekeeper" between maternal and fetal exposures, because it can reduce or enhance fetal exposure to various toxicants. Proposed mechanisms underlying toxicant-mediated damage include disrupted placental vasculogenesis, an up-regulated proinflammatory state, oxidative stressors contributing to prostaglandin production and consequent cervical ripening, uterine contractions, and ruptured membranes and epigenetic changes that contribute to disrupted regulation of endocrine and immune system signaling. The objective of this review is to provide an overview of studies examining the relationships between environmental contaminants in the US setting, specifically inorganic (eg, cadmium, arsenic, lead, and mercury) and organic (eg, per- and polyfluoroalkyl substances) toxicants, and the development of preeclampsia and preterm birth among women in the United States.

Risks of aflatoxin exposure among adolescents in boarding schools in Kilimanjaro region, Tanzania

School feeding in low-income countries is dominated by cereals and legumes, which are susceptible to aflatoxin contamination but are usually not assessed for aflatoxins. A cross sectional study was conducted to assess aflatoxin exposure among adolescents through consumption of school meals in Kilimanjaro region. Food frequency questionnaires and 24 h dietary recalls were used to collect information on food consumption. At least four samples of common food used in school meals were collected. A deterministic approach was used to estimate the dietary aflatoxin exposure. High Performance Liquid chromatography (HPLC) was used to analyse presence of aflatoxin contamination. Results showed that, maize based food and beans were consumed on daily basis. The intake of maize flour and dehulled maize ranged from 17.5 to 738.2 g and 28.2 to 272 g per person per day respectively. Furthermore, consumption of beans and rice were in the range of 121.1 to 595.2 g and 15.7 to 42.2 g per person per day respectively. Total aflatoxins ranged 0.20-438.53 μg/kg (median 2.30 μg/kg). The highest contamination range (0.59-438.53 μg/kg) was in maize while the lowest (0.20-3.41 μg/kg) was found in rice. Similarly, the highest aflatoxin B1 (AFB1) concentration (35.88 μg/kg) was in dehulled maize while the lowest (0.44 μg/kg) was in rice. The highest dietary exposure to total aflatoxins and AFB1 due to consumption of maize ranged from 0.70 to 973.45 ng/kg/bodyweight (bw)/day, and from 0.05-81.06 ng/kg/bw/day, respectively. This pronounced risk of exposure to aflatoxins might have been contributed by a monotonous maize based diet in boarding schools. These findings call for institutions immediate interventions, such as the use of appropriate storage technologies, sorting, cleaning and winnowing in order to remove damaged grains, thereby reducing the risk of dietary exposure to aflatoxins. Likewise, the relevant ministries should consider food diversification and routine risk assessments of the susceptible crops throughout the value chain as a long-term intervention plan at policy level.

Quality or Quantity of Proteins in the Diet for CKD Patients: Does "Junk Food" Make a Difference? Lessons from a High-Risk Pregnancy

BACKGROUND

How to manage patients with severe kidney disease in pregnancy is still a matter of discussion, and deciding if and when to start dialysis is based on the specialist's experience and dialysis availability. The effect of toxic substances usually cleared by the kidney may be more severe and readily evident. The review, and related case, underlines the importance of considering the presence of additives in food in delicate conditions, such as CKD pregnancy. The Case: A 39-year-old indigenous woman from a low-resourced area in Mexico was referred to the obstetric nephrology at 25 gestational weeks because of serum creatinine at 3.6 mg/dL, hypertension on low-dose alpha-methyl-dopa, and nephrotic-range proteinuria. Kidney ultrasounds showed small poorly differentiated kidneys; foetal ultrasounds detected a female foetus, normal for gestational age. The patient's baseline protein intake, which was estimated at 1.2-1.3 g/kg/day, was mostly of animal-origin (>70%) poor-quality food ("junk food"). In the proposed diet, protein intake was only slightly reduced (1.0-1.2 g/kg/day), but the source of proteins was changed (only 30% of animal origin) with attention to food quality. A remarkable decrease in BUN was observed, in concomitance with adequate dietary follow-up, with rapid rise of BUN when the patient switched temporarily back to previous habits. A healthy female baby weighing 2,460 g (11th centile for gestational age) was delivered at 37 gestational weeks. Discussion and Literature Review: While data on patients with chronic kidney disease are scant, the long list of contaminants present in food, especially if of low quality, should lead us to reflect on their potential negative effect on kidney function and make us realize that eating healthy, unprocessed "organic" food should be encouraged, in delicate conditions such as pregnancy and breastfeeding and for young children, in particular when kidney function is failing. The case herein described gave us the opportunity to reflect on the importance of diet quality and on the potential risks linked to food additives, many of which, including phosphates and potassium, are not declared on food labels, while others, including dyes, antioxidants, thickeners, emulsifiers, and preservatives, are qualitatively, but not quantitatively, reported.

Assessment of serum aflatoxin B1 levels in neonatal jaundice with glucose-6-phosphate dehydrogenase deficiency: a preliminary study

Aflatoxin (AF) contamination of food products is still a major health issue globally. Prior studies suggest that exposure to AFs during pregnancy has harmful fetal outcomes. This preliminary study was designed to assess serum AFB₁ levels in neonatal jaundice (NNJ) secondary to glucose-6-phosphate dehydrogenase (G6PD) deficiency. Twenty-four full-term neonates with hemolytic jaundice secondary to G6PD deficiency were enrolled in the study. Erythrocyte G6PD status was assessed colorimetrically, and serum aflatoxin B₁ (AFB₁) concentrations were measured by high-performance liquid chromatography. The results revealed that AFB₁ was detected in 58% (14/24) of the studied newborns while detected in 75% (18/24) of their mothers. AFB₁ positive cases had a highly significantly lower birthweight and G6PD activity (P = 0.001, each). Birthweight (r = - 0.574, P = 0.032) and G6PD activity (r = - 0.585, P = 0.028) negatively correlated with serum AFB₁ levels while serum alanine aminotransferase activity positively correlated with serum AFB₁ levels (r = 0.536, P = 0.048). Maternal AFB₁ exposure is associated with adverse birth outcomes as verified by the low birthweight and the evident decline in the activity of G6PD enzyme with the resultant hemolytic NNJ.

The importance of food systems and the environment for nutrition

Global and local food system transformation is necessary in order to ensure the delivery of healthy, safe, and nutritious foods in both sustainable and equitable ways. Food systems are complex entities that affect diets, human health, and a range of other outcomes including economic growth, natural resource and environmental resiliency, and sociocultural factors. However, food systems contribute to and are vulnerable to ongoing climate and environmental changes that threaten their sustainability. Although there has been increased focus on this topic in recent years, many gaps in our knowledge persist on the relation between environmental factors, food systems, and nutritional outcomes. In this article, we summarize this emerging field and describe what innovative nutrition research is needed in order to bring about food policy changes in the era of climate disruption and environmental degradation.

Nutrition and growth outcomes are affected by aflatoxin exposures in Kenyan children

Aflatoxin exposure, malnutrition and growth impairment in children present significant public health problems in low- and middle-income countries. Recent epidemiology studies show that exposure to aflatoxins through dietary sources in early life contributes to growth retardation among children. However, the findings remain inconclusive due to limited comparative studies in high versus low aflatoxin exposure regions. This cross-sectional study presents aflatoxin exposure levels among children aged 6 to 12 years, and further evaluates the association between aflatoxin exposure levels, malnutrition and growth impairment in Kenya, East Africa. AFB₁-lysine adducts are validated biomarkers of exposure and were quantified using HPLC with fluorescence detection. All children (n = 746) had detectable levels of AFB₁-lysine adducts in serum, range 0.65-518.9 pg/mg albumin with a geometric mean (GM) of 10.5 (95%CI 9.4-11.7) pg/mg albumin. The Geometric Means (GM) of AFB₁-lysine adducts were 14.0 (95%CI 12.5, 15.7) pg/mg albumin and 8.2 (95%CI 7.6, 8.8) pg/mg albumin (p-value < 0.001), among children recruited from Makueni and Siaya Counties, respectively. While the study confirms higher human exposure levels in Makueni county, it provides an initial data set for aflatoxin exposure levels among children recruited from Siaya County. In multivariate analysis, after adjusting for socio-economic indicators, farming practices, and household dietary patterns, increasing one unit of log AFB₁-lysine was associated with decreasing Weight-for-age z-score (WAZ) by -0.13, p-value = 0.019 among all children aged 6-12 years. Among children 6 to 9 years, WAZ decreases by -0.11 (-0.54, -0.01), p-value = 0.049. Additional growth parameters Height-for-age z-score (HAZ) and Weight-for-height z-score (WHZ) do not reach statistical significance. HAZ decreases by -0.08, p-value = 0.337 and WHZ decreases by -0.17, p-value = 0.437 with every increase in log AFB₁-lysine. These data suggest that efforts must be put in place to control for aflatoxin exposure in order to achieve better growth outcomes.

Aflatoxin contamination of human breast milk and complementary foods in southern Ethiopia

Exposure to unsafe level of aflatoxin in early life may lead to growth faltering. However, the extent of contamination of breast milk and complementary foods is poorly examined. We determined aflatoxin M₁ (AFM₁ ) and B₁ (AFB₁ ) contamination of human breast milk and cereal-based cooked complementary foods, respectively, among households having children 6-23 months of age in Sidama zone, southern Ethiopia. Data were collected through two cross-sectional surveys implemented in the wet (n = 180) and dry (n = 180) seasons. Eligible households (n = 360) were recruited from three agroecological zones (lowland, midland and highland, each with sample size of 120) using a multistage sampling technique. AFB₁ and AFM₁ levels were determined using enzyme-linked immunosorbent assay. Mann-Whitney U and Kruskal-Wallis tests were performed to compare aflatoxin levels between seasons and across the agroecological zones. Among 360 breast milk samples tested, 64.4% had detectable AFM₁ and 5.3% exceeded the 0.025 parts per billion (ppb) limit set by the European Union for infant milk. The median AFM₁ in the lowlands was significantly higher than in the other agroecological settings (P < 0.001). By season, AFM₁ was higher in breast milk samples collected in the dry season (P = 0.041). AFB₁ was detected in 96.4% of the food samples tested, and 95.0% had concentration exceeding the permissible European Union limit of 0.1 ppb. The median AFB₁ was significantly higher in the lowland (P = 0.002), but there was no difference between the seasons (P = 0.386). The study indicated that, in southern Ethiopia, foods intended for infants are heavily contaminated with AFB₁ . Contamination of breast milk is also a significant health concern.

Mycotoxin exposure and pregnancy

Pregnancy is not a disease condition; it is a physiological process. However, the risks prevail until this process ends. While many pregnancies and births culminate without any problems, a considerable number of them end up with undesirable pregnancy outcomes such as intrauterine growth retardation, preterm labor, and low birth weight infants. Although the causes of these negative pregnancy outcomes are not fully understood, they occur in a multifactorial ways. One of the important issues here is the foods consumed by women with pregnancy. Pregnant women should avoid consuming fast food products, alcohol, or tobacco, which are already known to be harmful to human health, as well as harmful natural products containing mycotoxins. Mycotoxins are natural toxins with a wide range of chemical structures. While people can get these toxins directly from agricultural products, they can also be exposed indirectly through products of animals fed with contaminated feed. Mycotoxins have negative impacts on human health with their carcinogenic, teratogenic, and mutagenic effects. There are some evidences that mycotoxins can lead to negative pregnancy outcomes. These possible negative effects have been determined to be lower birth weight, neonatal jaundice, fetal loss, fetal defects, preterm birth, maternal anemia, and preeclampsia. However, more evidence is needed on this topic. This review aims to investigate the adverse effects of mycotoxins during pregnancy.

Aflatoxin exposure in pregnant women of mixed status of human immunodeficiency virus infection and rate of gestational weight gain: a Ugandan cohort study

Objectives

To examine the association between aflatoxin (AF) exposure during pregnancy and rate of gestational weight gain (GWG) in a sample of pregnant women of mixed HIV status in Gulu, northern Uganda.

Methods

403 pregnant women were included (133 HIV‐infected on antiretroviral therapy (ART), 270 HIV‐uninfected). Women’s weight, height and socio‐demographic characteristics were collected at baseline (~19 weeks’ gestation); weight was assessed at each follow‐up visit. Serum was collected at baseline and tested for aflatoxin B₁‐lysine adduct (AFB‐lys) levels using high‐performance liquid chromatography (HPLC). Linear mixed‐effects models were used to examine the association between AFB‐lys levels and rate of GWG.

Results

AFB‐lys levels (detected in 98.3% of samples) were higher among HIV‐infected pregnant women than HIV‐uninfected pregnant women [median (interquartile range): 4.8 (2.0, 15.0) vs. 3.5 (1.6, 6.1) pg/mg of albumin, P < 0.0001]. Adjusting for HIV status, a one‐log increase in aflatoxin levels was associated with a 16.2 g per week lower rate of GWG (P = 0.028). The association between AFB‐lys and the rate of GWG was stronger and significant only among HIV‐infected women on ART [−25.7 g per week per log (AFB‐lys), P = 0.009 for HIV‐infected women vs. −7.5 g per week per log (AFB‐lys), P = 0.422 for HIV‐uninfected women].

Conclusions

Pregnant women with higher levels of AF exposure had lower rates of GWG. The association was stronger for HIV‐infected women on ART, suggesting increased risk.

Early exposure to food contaminants reshapes maturation of the human brain-gut-microbiota axis

Early childhood growth and development is conditioned by the consecutive events belonging to perinatal programming. This critical window of life will be very sensitive to any event altering programming of the main body functions. Programming of gut function, which is starting right after conception, relates to a very well-established series of cellular and molecular events associating all types of cells present in this organ, including neurons, endocrine and immune cells. At birth, this machinery continues to settle with the establishment of extra connection between enteric and other systemic systems and is partially under the control of gut microbiota activity, itself being under the densification and the diversification of microorganisms' population. As thus, any environmental factor interfering on this pre-established program may have a strong incidence on body functions. For all these reasons, pregnant women, fetuses and infants will be particularly susceptible to environmental factors and especially food contaminants. In this review, we will summarize the actual understanding of the consequences of repeated low-level exposure to major food contaminants on gut homeostasis settlement and on brain/gut axis communication considering the pivotal role played by the gut microbiota during the fetal and postnatal stages and the presumed consequences of these food toxicants on the individuals especially in relation with the risks of developing later in life non-communicable chronic diseases.