Analysis of Aflatoxin M1 in Breast Milk and Its Association with Nutritional and Socioeconomic Status of Lactating Mothers in Lebanon

Determination of aflatoxin M1 and ochratoxin A in breast milk in rural centers of Yazd, Iran: Exposure assessment and risk characterization

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.

Mycotoxin contamination in the Arab world: Highlighting the main knowledge gaps and the current legislation

Since the discovery of aflatoxins in the 1960s, knowledge in the mycotoxin research field has increased dramatically. Hundreds of review articles have been published summarizing many different aspects, including mycotoxin contamination per country or region. However, mycotoxin contamination in the Arab world, which includes 22 countries in Africa and Asia, has not yet been specifically reviewed. To this end, the contamination of mycotoxins in the Arab world was reviewed not only to profile the pervasiveness of the problem in this region but also to identify the main knowledge gaps imperiling the safety of food and feed in the future. To the best of our knowledge, 306 (non-)indexed publications in English, Arabic, or French were published from 1977 to 2021, focusing on the natural occurrence of mycotoxins in matrices of 14 different categories. Characteristic factors (e.g., detected mycotoxins, concentrations, and detection methods) were extracted, processed, and visualized. The main results are summarized as follows: (i) research on mycotoxin contamination has increased over the years. However, the accumulated data on their occurrences are scarce to non-existent in some countries; (ii) the state-of-the-art technologies on mycotoxin detection are not broadly implemented neither are contemporary multi-mycotoxin detection strategies, thus showing a need for capacity-building initiatives; and (iii) mycotoxin profiles differ among food and feed categories, as well as between human biofluids. Furthermore, the present work highlights contemporary legislation in the Arab countries and provides future perspectives to mitigate mycotoxins, enhance food and feed safety, and protect the consumer public. Concluding, research initiatives to boost mycotoxin research among Arab countries are strongly recommended.

Assessment of mycotoxins in cornflakes marketed in Lebanon

Cornflakes are a popular and convenient breakfast cereal made from corn and widely consumed worldwide, including in Lebanon. However, they are susceptible to mycotoxin contamination, which can have harmful effects on human health. Our study evaluated the occurrence of five mycotoxins (AFB1, OTA, FUM, ZEA, DON) levels in packed cornflakes marketed in Lebanon. A market screening identified 35 different cornflake stock-keeping units (SKU) in the Lebanese market, originating from 10 different brands and having different tastes and shapes. SKUs were collected and tested for five mycotoxins in triplicates using enzyme-linked immunosorbent assay technique. The results showed the presence of the five mycotoxins in the samples. The average levels of AFB1, OTA, ZEA and FUM among positive samples (above limit of detection) were 1.58, 1.2, 15.1 and 774.1 μg/kg, respectively, and were below the EU limits. On the other hand, the average level of DON was 1206.7 μg/kg, exceeding the EU limit. Furthermore, out of the positive samples, 60%, 17%, 9%, 14%, and 6% exceeded the EU limits for DON, OTA, AFB1, FUM, and ZEA, respectively. Notably, SKUs made in Lebanon had significantly (p < 0.05) higher levels of AFB1 and FUM. The packing size of the cornflakes had no significant (p > 0.05) effect on the levels of the five mycotoxins detected in the samples. AFB1, FUM and ZEA levels differed significantly among SKUs (p > 0.05). Considering these findings, further studies should be conducted to assess the exposure to mycotoxins from the consumption of cornflakes in Lebanon, especially among children.

Aflatoxins and Ochratoxin A in Tea Sold in Lebanon: Effects of Type, Packaging, and Origin

Tea is among the oldest and most-known beverages around the world, and it has many flavors and types. Tea can be easily contaminated in any of its production steps, especially with mycotoxins that are produced particularly in humid and warm environments. This study aims to examine the level of ochratoxin A (OTA) and total aflatoxin (AF) contamination in black and green tea sold in Lebanon, evaluate its safety compared to international standards, and assess the effect of different variables on the levels of OTA and AFs. For this, the Lebanese market was screened and all tea brands (n = 37; 24 black and 13 green) were collected twice. The Enzyme-Linked Immunoassay (ELISA) method was used to determine OTA and AFs in the samples. AFs and OTA were detected in 28 (75.7%) and 31 (88.6%) samples, respectively. The average of AFs in the positive (above detection limit: 1.75 μg/kg) samples was 2.66 ± 0.15 μg/kg, while the average of OTA in the positive (above detection limit: 1.6 μg/kg) samples was 3.74 ± 0.72 μg/kg. The mean AFs in black and green tea were 2.65 ± 0.55 and 2.54 ± 0.40 μg/kg, respectively, while for OTA, the mean levels were 3.67 ± 0.96 and 3.46 ± 1.09 μg/kg in black and green tea samples, respectively. Four brands (10.8%) contained total aflatoxin levels above the EU limit (4 μg/kg). As for OTA, all samples had OTA levels below the Chinese limit (5 μg/kg). No significant association (p > 0.05) was found between OTA and tea type, level of packaging, country of origin, country of packing, and country of distribution. However, AF contamination was significantly (p < 0.05) higher in unpacked tea, and in brands where the country of origin, packing, and distributor was in Asia. The results showed that the tea brands in Lebanon are relatively safe in terms of AFs and OTA.

Mycotoxins Exposure of Lactating Women and Its Relationship with Dietary and Pre/Post-Harvest Practices in Rural Ethiopia

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.

Perfluorooctanoic Acid and Perfluorooctane Sulfonate in Human Milk: First Survey from Lebanon

Human milk is the primary source of nutrition for infants in their first year of life. Its potential contamination with perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS), a group of toxic man-made chemicals, is a health concern that may threatens infants' health. Our study aims to assess the levels of PFOA and PFOS in the breast milk of Lebanese lactating mothers and the maternal factors associated with their presence. High-performance liquid chromatography (HPLC) coupled with a Micromass Quattro micro API triple quadrupole mass spectrometer was used to detect the level of contamination in 57 collected human milk samples. PFOA and PFOS were present in 82.5% and 85.7% of the samples, respectively, while PFOA levels ranged between 120 and 247 pg/mL with a median of 147 pg/mL, and those of PFOS ranged between 12 and 86 pg/mL with a median of 27.5 pg/mL. The median contamination for PFOA exceeded the threshold set by the European Food Safety Authority (EFSA) (60 pg/mL); however, that of PFOS was below the threshold (73 pg/mL). The consumption of bread, pasta, meat, and chicken more than twice per week and that of white tubers and roots at least once per week was significantly associated with higher levels of PFOA (p < 0.05). No significant association was found between maternal age, BMI, parity, level of education, place of residence, source of water used, and smoking with the levels of PFOA and PFOS in the human milk. Additionally, the consumption of cereals at least twice per week was significantly associated with higher levels of PFOS. These findings call for actions to improve the local environmental and agricultural practices, and the regulations and standards for inspecting imported food. It is important to highlight that the benefits of breastfeeding outweigh the reported contamination with PFOS and PFOA in our study.

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.

Phenolic Compounds Recovery from Blood Orange Peels Using a Novel Green Infrared Technology Ired-Irrad®, and Their Effect on the Inhibition of Aspergillus flavus Proliferation and Aflatoxin B1 Production

The intensification of total phenolic compound (TPC) extraction from blood orange peels was optimized using a novel green infrared-assisted extraction technique (IRAE, Ired-Irrad^®) and compared to the conventional extraction using a water bath (WB). Response surface methodology (RSM) allowed for the optimization of ethanol concentration (E), time (t), and temperature (T) in terms of extracted TPC and their antiradical activity, for both WB extraction and IRAE. Using WB extraction, the multiple response optimums as obtained after 4 h at 73 °C and using 79% ethanol/water were 1.67 g GAE/100 g for TPC and 59% as DPPH inhibition percentage. IRAE increased the extraction of TPC by 18% using 52% ethanol/water after less than 1 h at 79 °C. This novel technology has the advantage of being easily scalable for industrial usage. HPLC analysis showed that IRAE enhanced the recovery of gallic acid, resveratrol, quercetin, caffeic acid, and hesperidin. IR extracts exhibited high bioactivity by inhibiting the production of Aflatoxin B1 by 98.9%.

Determination of aflatoxin M1 in breast milk and related factors

OBJECTIVE:

Breastfeeding in women with aflatoxin M1 exposure may be a risk factor for the newborn. Thus, it is crucial to determine aflatoxin M1 levels in breast milk and raise mothers’ awareness about nutrition in lactation and other periods. This study was carried out to determine aflatoxin M1 contamination in milk samples taken from mothers who gave birth.

METHODS:

The study was carried out in the postpartum department of Training and Research Hospital between December 31, 2018, and June 31, 2019, and 90 breastfeeding mothers were included in the study.

RESULTS:

A total of 75 (83.3%) of the examined samples were found positive. The mean aflatoxin M1 ratio in positive samples was 12.16 pg/mL (5.00–23.18 pg/mL). Mothers’ consumption of processed food was associated with aflatoxin M1 levels (p=0.043). It was determined that the aflatoxin M1 levels of mothers who consumed processed food products 1 or 2 times a month were 3.22 times lower than those who consumed 1–2 times a week.

CONCLUSIONS:

This study emphasized the importance of monitoring aflatoxin M1 levels in breast milk for infant health. It is thought that nutrition education given to mothers during pregnancy will significantly impact aflatoxin M1 results. In addition, the dangers of mycotoxins in mother-infant nutrition should be emphasized regularly in health education.

Aflatoxin B1 in Rice: Effects of Storage Duration, Grain Type and Size, Production Site, and Season

ABSTRACT

Our study evaluated aflatoxin B1 (AFB1) levels in packed rice marketed in Lebanon and determined the exposure to this toxin from rice consumption. A total of 105 packed white, parboiled, and brown rice bags were collected. Enzyme-linked immunosorbent assay was used to measure AFB1. A comprehensive food frequency questionnaire was completed by 500 participants to determine patterns of rice consumption and, subsequently, the exposure levels to AFB1 from rice consumption in Lebanon. AFB1 was detected in all rice samples (100%). The average concentration ± standard deviation of AFB1 was 0.5 ± 0.3 μg/kg. Contamination ranged between 0.06 and 2.08 μg/kg. Moisture content in all rice samples was below the recommended percentage (14%). Only 1% of the samples had an AFB1 level above the European Union limit (2 μg/kg). Brown rice had a significantly higher AFB1 level than white and parboiled rice (P = 0.02), while a significant difference was found between both collections for the same brands (P = 0.016). Packing season, packing country, country of origin, presence of a food safety management certification, grain size, and time between packing and purchasing had no significant effect. Exposure to AFB1 from rice consumption in Lebanon was calculated as 0.1 to 2 ng/kg of body weight per day.

HIGHLIGHTS

Influence of season and lactational stage on aflatoxin M1 and ochratoxin A in human milk in a cohort study from southeastern region of Turkey

The aim was to evaluate the changes in aflatoxin M1 (AFM1) and ochratoxin A (OTA) levels in human breast milk (HBM) during the first five postpartum months according to the sampling season in a cohort study from Şanlıurfa. From 78 healthy lactating mothers, HBM was taken at the 5-14 days postpartum (D5-14) and the 6^th and 18^th weeks postpartum (W6 and W18). Mycotoxin levels were analyzed with competitive ELISA. Generalized Estimating Equations with repeated measures (three-correlation matrix dimension) revealed a significantly higher mean AFM1 level at W6 than that on D5-14. AFM1 and OTA levels in winter and spring were considerably higher than that in summer and autumn. Maternal smoke exposure, body mass index, history of moldy food exposure, birth order, and breastfeeding type did not influence the results. Whilst season had a marked effect on the milk levels of both analytes, lactation stage affected AFM1 more notable than OTA.

Mycotoxins Exposure in Cabinda, Angola-A Pilot Biomonitoring Survey of Breastmilk

Breast milk is considered the ideal form of nutrition for newborns and infants. However, it can carry over contaminants, namely mycotoxins, with biological effects to which this population is particularly vulnerable. Human biomonitoring and surveillance programs are particularly scarce in low-income countries, where food security is a more urgent priority in comparison with food safety. This pilot survey aims to assess exposure of breastfed infants to aflatoxin M1 (AFM1), zearalenone (ZEN), and ochratoxin A (OTA) in Angola, and to evaluate the main socio-demographical and food consumption determinants of lactating mothers. All 37 breast milk samples analyzed are found to be contaminated with ZEN and OTA, although none are found contaminated with AFM1. Contamination levels are lower than previously reported for ZEN but higher in the case of OTA. A significant association between ZEN levels in breast milk and the consumption of cookies by the lactating mothers is found. As for OTA, higher levels are observed in the milk from mothers with younger infants, for which high estimated daily intake (EDI) is determined. As far as the authors are aware, this is the first survey of the occurrence of mycotoxins in breast milk in Angola, so further human biomonitoring works should follow, given that mycotoxins are a global health issue that directly impact the health of populations.

Levels of Aflatoxin M1 in Breast Milk of Lactating Mothers in Monterrey, Mexico: Exposure and Health Risk Assessment of Newborns

The present study aimed to determine the presence of the aflatoxin M1 (AFM1) in breast milk samples from 123 nursing women and the degree of exposure of infants to this toxin, in the metropolitan area of Monterrey, Nuevo Leon state (northeast Mexico). Upon analysis, 100% of the samples were found to be contaminated with the toxin at an average concentration of 17.04 ng/L, with a range of 5.00 to 66.23 ng/L. A total of 13.01% of the breast milk samples exceeded the regulatory limit of 25 ng/L for AFM1 concentration, set by the European Union. The estimated daily intake for AFM1 and the carcinogenic risk index were also determined in the 0- to 6-, 7- to 12-, 13- to 24-, and 25- to 36-month-old age groups. The AFM1 intake through breast milk ranged from 1.09 to 20.17 ng/kg weight/day, and was higher than the tolerable daily intake, indicating a carcinogenic risk for infants in the age groups of 0- to 24-months old. This evidence demonstrates a susceptibility of breast milk to AFM1 contamination that may suggest a carcinogenic risk for the breastfed infants in Monterrey city, Nuevo Leon state, and the need to control the presence of aflatoxins in foods eaten by nursing mothers.

Persistent Organic Pollutants in Human Milk: Exposure Levels and Determinants among Lactating Mothers in Lebanon

ABSTRACT

Exposure of newborns to persistent organic pollutants (POPs) is a public health concern. The objective of this study was to assess the prevalence of POPs in human milk collected from lactating mothers in Lebanon and to investigate the sociodemographic, nutritional, and other lifestyle determinants. Fifty-four breast milk samples were collected as per World Health Organization guidelines. A survey was used to assess the anthropometric and demographic characteristics of participants. Dietary habits were evaluated based on a semiquantitative food frequency questionnaire. Organochlorine pesticides and polychlorinated biphenyls were measured in milk samples with liquid-liquid extraction and gas chromatography. Among the screened POPs, dichlorodiphenyldichloroethylene (DDE) was the only POP detected in breast milk samples and was found in only 17.9% of the samples, with a mean (SD) of 11.6 (5.0) μg/L and a range of 5.7 to 21.4 μg/L. Prepregnancy body mass index and age were positively associated with DDE contamination in breast milk. Women who consumed cereals at least two times per week had detectable DDE contamination in their breast milk. Consumption of potatoes and beans at least once per week was also associated with DDE contamination. Our study is the first to assess the presence of POPs in breast milk in Lebanon. The benefits of breastfeeding compensate for the low prevalence of DDE in the breast milk. Our findings highlight the high need to implement monitoring policies, good agricultural practices, and education programs for breastfeeding mothers.

HIGHLIGHTS

Human Biomonitoring of Selected Hazardous Compounds in Portugal: Part II—Lessons Learned on Mycotoxins

Human biomonitoring (HBM) data provide information on total exposure regardless of the route and sources of exposure. HBM studies have been applied to quantify human exposure to contaminants and environmental/occupational pollutants by means of determining the parent compounds, their metabolites, or even their reaction products in biological matrices. HBM studies performed among the Portuguese population are dispersed and limited. Thus, to overcome this knowledge gap, this work reviews the published Portuguese HBM information concerning mycotoxins detected in the urine, serum, milk, hair, and nails of different groups of the Portuguese population. This integrative approach to the available HBM data allows us to analyze the main determinants and patterns of exposure of the Portuguese population to the selected hazardous compounds, as well as to assess the potential health risks. We also aimed to identify the main difficulties and challenges of HBM through the analysis of the enrolled studies. Ultimately, this study aims to support national and European policies in promoting human health by summarizing the most important outcomes and lessons learned through the HBM studies carried out in Portugal.

Aflatoxin exposure among lactating women in southern Ethiopia

In Ethiopia and many other low-income countries, little is known about the exposure of lactating women to aflatoxin, which is a major health concern to the mother and her nursing infant. We determined the aflatoxin B1 contamination of family foods (AFB1) and urinary aflatoxin M1 (AFM1) of lactating women in Sidama, southern Ethiopia, and compared the levels across agroecological settings (lowland, midland, highland) and two seasons. We conducted two surveys (n = 360) that represented the dry and wet seasons of the locality. AFM1 and AFB1 were determined using enzyme-linked immunosorbent assay (ELISA). Statistical analysis was made using Mann-Whitney U test and Kruskal-Wallis test. The median (interquartile range) AFB1 was 0.94 (0.63-1.58) ppb. AFB1 was detected in 95.6% of the food samples, and 13.6% exceeded the 2.0 ppb threshold. We observed an increasing trend for aflatoxin exposure from highland to lowland (p < .001), but there was no difference between seasons (p = .743). The median (interquartile range) urinary AFM1 was 214 (undetectable to 2,582) ppt, and AFM1 was detectable in 53.3% of the samples. Urinary AFM1 showed significant difference among agroecological zones (p < .001) but not between seasons (p = .275). A significant but weak correlation was observed between AFB1 and urinary AFM1 (rs  = 0.177, p = .001). We concluded that lactating women in Sidama, especially those in the lowland area, have unsafe exposure to aflatoxin.

An assessment of the occurrence and nutritional factors associated with aflatoxin M1, ochratoxin A, and zearalenone in the breast milk of nursing mothers in Hamadan, Iran

This research investigated the occurrence of aflatoxin M1 (AFM1), ochratoxin A (OTA), and zearalenone (ZEN) in human milk samples in the Hamadan city, Iran. The study was carried out using the milk of nursing mothers from ten governmental health care centers. Mycotoxin content of ninety milk samples measured using enzyme-linked immunosorbent assay (ELISA). All samples that tested positive for AFM1 with the ELISA test were subsequently analyzed by high-performance liquid chromatography (HPLC). The mean ± SD concentrations of AFM1, determined by ELISA and HPLC were 5.98 ± 1.47 and 4.36 ± 1.23 ng/L, respectively. OTA and ZEN levels were below the detection limit (<5 ng/L) in all samples. None of the contaminated samples exceeded the regulation limit set by the European Commission (25 ng/L) for AFM1 in infant formula. We found a significant correlation between the AFM1 concentration in breast milk and infant age and milk consumption by the nursing mother (p < 0.05). These findings revealed that infants are susceptible to AFM1 exposure from their mother's milk. The authors recommend that additional research be conducted on the analysis of foodstuff and biological fluids for various mycotoxins.

Aflatoxin M1 prevalence in breast milk in Morocco: Associated factors and health risk assessment of newborns "CONTAMILK study"

The aim of this study was to assess the contamination of breast milk by aflatoxin M1 among nursing mothers from Rabat, Morocco, and to explore its association with several maternal parameters and dietary habits. In addition, the health risk assessment of the newborns by the estimation of the daily intake. A competitive Enzyme Linked Immunosorbent Assay method was used for the analysis of aflatoxin M1 in breast milk samples. Analytical results indicate that out of 82 total samples, 43 samples (52.4%) of milk were positive. Aflatoxin M1 levels ranged from undetectable to 13.33 ng/L, while the mean level was 5.75 ± 3.44 ng/L. Besides, several factors and foodstuffs seem to increase the level of AFM1 in breast milk. As regards the estimated daily intake of aflatoxin M1, it varies between immeasurable and a maximum of 1.16 ng/kg.bw. The degree of exposure to AFB1 and the levels of its metabolite AFM1 in breast milk were low, compared to some studies from other countries. Further investigations and periodic monitoring programs are recommended in large samples and in many cities of morocco to assess the level of exposure of the Moroccan population.

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.

Dietary Intake of Mycotoxin Susceptible Foods by Brazilian Nursing Mothers

Background:

The human milk has several health benefits to the mother and child, and it is the ideal form of nutrition for infants. However, some food contaminants such as mycotoxins can be transferred from the mother to the child through breast milk.

Objective:

To access the dietary intake of mycotoxin susceptible foods by nursing mothers.

Methods:

The dietary intake of mycotoxin susceptible foods was investigated by interviewing nursing mothers (n = 86), who were registered donors of the Human Milk Bank (HMB) of Blumenau (Brazil), through a food frequency questionnaire (FFQ). The mothers were contacted and those who agreed to answer the FFQ were recruited for the study group. The interview was conducted individually, face to face with each mother, by a trained researcher. The FFQ was divided into three food Groups (vegetables, animal and beverages, respectively), considered most prone to mycotoxins contamination. Socio-demographic characteristics of the mothers were also obtained.

Results:

The FFQ revealed a high weekly intake of foods susceptible to fungi and mycotoxin contamination. Consumption of wheat, coffee and cow’s milk was reported by 52, 44 and 51% of the mothers, respectively. The consumption of those foods occurred daily to more than 7 times per week.

Conclusion:

The study revealed that Brazilian nursing mothers frequently consume foods susceptible to mycotoxin contamination, especially wheat and its by-products. Brazilian health, environmental and agriculture authorities should pay permanent attention by applying monitoring programs to grains and cereals - both imported and domestically produced - as they are highly susceptible to fungi and mycotoxin contamination, which can be transferred to infants via breastfeeding, apart from harming the general population health.

Gallic acid enhances reproductive function by modulating oxido-inflammatory and apoptosis mediators in rats exposed to aflatoxin-B1

IMPACT STATEMENT

Infertility resulting from reproductive deficiency can be stressful. Exposure to aflatoxin B1, a dietary mycotoxin prevalent in improperly stored grains, is reported to elicit reproductive insufficiencies and infertility. We, therefore, examined the likely beneficial effect of gallic acid (GA) a phytochemical, recognized to exhibit in vitro and in vivo pharmacological bioactivities against oxidative stress and related inflammatory damages in rats, since AFB1 toxicities are predicated on oxidative epoxide formation, in a bid to proffer new evidence to advance the field of nutriceutical application from plant-derived chemopreventive agents. Our findings will advance the field of chemoprevention by presenting data absent in the literature on GA. Our results demonstrate further evidence for GA conferred protection against AFB1-mediated histological lesions in testes, epididymis, and hypothalamus of treated rats; suppresses oxidative damages, relieved inflammatory and apoptotic responses, restored sperm functional characteristics, and hormonal levels relevant for reproductive integrity and function.

Mycotoxin toxicity and residue in animal products: Prevalence, consumer exposure and reduction strategies - A review

Mycotoxin residues are transferred from feed to animal products, yet, less attention has been paid to it in developing countries. There is a need to find alternative alleviation material for reducing the impact of mycotoxin. This review is meant to elucidate different additives that can reduce mycotoxin residue in animal products in the world, especially in developing countries. There is evidence of relationship between mycotoxin residue in breast milk of nursing mothers and mycotoxin exposure through crop and animal product (egg and milk) intake, especially in Asia, Africa, Middle East, Latin America, and some parts of Europe. Younger livestock tends to have more toxin residues in their tissue compared to older ones. Grazing animal are also exposed to mycotoxin intake which corresponds to high level of mycotoxins in their products including meat and milk. This review shows that phytogenic, probiotic, and prebiotic additives can decrease mycotoxin residues in milk, eggs, meat liver and other tissues of livestock. Specifically, bentonites, difructose anhydride III, yeast (Trichosporon mycotoxinivorans), Bacillus spp., or their biodegradable products can reduce mycotoxin residue in animal products. In addition, Ally isothiocyanates from mustard seed were able to mitigate mycotoxins in silo-simulated system. Evidence shows that there are now low-cost, accessible, and eco-friendly additives, which could alleviate the effect of mycotoxin in feed and food. In addition, there is need for aggressive public awareness and farmers' education on the prevalence, and danger caused by mycotoxins, as well as detoxification strategies that can reduce toxin absorption into animal products.

Concentration and Prevalence of Aflatoxin M1 in Human Breast Milk in Iran: Systematic Review, Meta-Analysis, and Carcinogenic Risk Assessment: A Review

This meta-analysis was designed to review the published reports regarding the concentration and/or prevalence of aflatoxin M₁ (AFM₁) in human breast milk in Iran. The carcinogenic risk for Iranian infants consuming this milk was estimated with the hazard index. The PubMed and Scopus databases and the Scientific Information Database were screened for relevant studies between 1995 and 2017, and 11 of the 112 collected studies were included in the systematic review and meta-analysis. The mean (95% confidence interval) concentration of AFM₁ was 5.85 ng/L (4.54 to 7.15 ng/L), which was lower than the European Union standard (25 ng/L). The mean prevalence of AFM₁ in breast milk in Iran was 42% (11 to 77%). The estimated daily intakes for male and female infants were 0.02 to 5.57 ng/kg and 0.02 to 3.68 ng/kg of body weight per day, respectively. The rank order of estimated daily intake for both male and female infants according to age was 1 week > 1 month > 6 months > 12 months. The hazard index for all age groups of infants in all provinces in Iran was less than 1. Therefore, infants in Iran were not considered at carcinogenic risk from AFM₁ in human breast milk.

Human milk mycotoxin contamination: smoking exposure and breastfeeding problems

Purpose: Mammalian milk may contain pollutants as a result of the maternal exposure. The objective was to determine the presence of selected mycotoxins in human milk and to investigate the effect of maternal characteristics on breastmilk mycotoxin levels and to examine the effect of mycotoxin contamination on lactational problems.Materials and methods: Information about maternal characteristics were taken by a questionnaire and breast milk samples were collected. Levels of aflatoxins M1 (AFM1), ochratoxins A (OTA), zearalenone (ZEN), Deoxynivalenol (DON) were determined by the solid-phase direct competitive enzyme immunoassay.Results: Median levels of breast milk AFM1 and OTA was 3.07 pg/mL and 1.38 ng/mL, respectively. ZEN and DON levels were higher than 0.3 ng/mL in 59% and higher than 10 ng/mL in 37.7%. After controlling for confounding factors, mothers who experienced "delayed onset of lactogenesis" had odds 3.33 times more for the highest quartile of ZEN and mothers with cracked nipples had odds 8.36 times more for the highest quartile of DON. Multiple regression analysis revealed that smoking exposure (environmental, maternal smoking versus never) significantly affected being in the highest quartile of OTA.Conclusion: Mycotoxin can pass to breast milk and smoking exposure of the mother may influence this situation. Mycotoxin exposure may lead to lactation problems. Maternal and infant health can be protected by preventing smoking exposure.

Effects of Mycotoxins on Neuropsychiatric Symptoms and Immune Processes

PURPOSE

The effects of air pollutants have been receiving increased attention both clinically and in the media. One such pollutant is mold, fungal growth in the form of multicellular filaments known as hyphae. The growth of molds is omnipresent not only in outdoor settings but also in indoor environments containing excessive amounts of moisture.

METHODS

PubMed was searched for relevant articles using terms such as mold, mycotoxins, fungi, immunity, inflammation, neurodevelopment, cognition, Alzheimer's, and autism.

FINDINGS

Exposure to molds is most commonly associated with allergies and asthma. However, it is now thought to be associated with many complex health problems, since some molds, especially Trichoderma, Fusarium and Stachybotrys spp, produce mycotoxins that are absorbed from the skin, airways, and intestinal lining. People exposed to molds and mycotoxins present with symptoms affecting multiple organs, including the lungs, musculoskeletal system, as well as the central and peripheral nervous systems. Furthermore, evidence has recently implicated exposure to mycotoxins in the pathogenesis of autism spectrum disorder. The effects of mycotoxins can be mediated via different pathways that include the secretion of pro-inflammatory cytokines, especially from mast cells.

IMPLICATIONS

The information reviewed indicates that exposure to mold and mycotoxins can affect the nervous system, directly or through immune cell activation, thus contributing to neurodevelopmental disorders such as autism spectrum disorder.