Abstract
Exposure to aflatoxin, a mycotoxin common in many foods, has been associated with child growth impairment in sub-Saharan Africa. To improve our understanding of growth impairment in relation to aflatoxin and other risk factors, we assessed biospecimens collected in Nepalese children at 15, 24, and 36 months of age for aflatoxin exposure. Children (N = 85) enrolled in the Bhaktapur, Nepal MAL-ED study encompassed the cohort analysed in this study. Exposure was assessed through a plasma biomarker of aflatoxin exposure: the AFB1-lysine adduct. The aflatoxin exposures in the study participants were compared to anthropometrics at each time period (length-for-age [LAZ], weight-for-age [WAZ], and weight-for-length [WLZ] z-scores), growth trajectories over time, age, and breastfeeding status. Results demonstrated chronic aflatoxin exposure in this cohort of children, with a geometric mean of 3.62 pg AFB1-lysine/mg albumin. However, the chronic aflatoxin exposure in this cohort was not significantly associated with anthropometric z-scores, growth trajectories, age, or feeding status, based on the available time points to assess aflatoxin exposure. Low mean levels of aflatoxin exposure and infrequent occurrence of stunting, wasting, or underweight z-score values in this cohort are possible contributing factors to a lack of evidence for an association. Further research is needed to examine whether a threshold dose of aflatoxin exists that could induce child growth impairment.
Highlights
For over 50 years, the dietary mycotoxin aflatoxin has been known to cause liver cancer in experimental models and in people; but only more recently has interest grown in whether aflatoxin impairs the growth of children
Plasma samples from 85 children enrolled in the MAL-ED cohort were included in this analysis; plasma samples collected at 15, 24, and 36 months were analyzed for the AFB1-lysine (AFB1-lys) adduct
Data from Nepal suggests that stunting increases with age; among children 9–11 months stunting has been reported to be 14%, while children that are 36–47 months old have a rate of 53% [29]
Summary
For over 50 years, the dietary mycotoxin (fungal toxin) aflatoxin has been known to cause liver cancer in experimental models and in people; but only more recently has interest grown in whether aflatoxin impairs the growth of children. The most potent naturally occurring chemical liver carcinogen, aflatoxin is produced primarily by the fungi Aspergillus flavus and A. parasiticus, which frequently affect crops in warm climates. Aflatoxin contaminates staple foods such as maize and peanuts, resulting in chronic, substantial exposure in populations with uniform diets focused primarily around maize- and peanut-based foods. In addition to its carcinogenic effects, aflatoxin exposure has been associated with immune dysfunction, growth faltering, and–at high doses–death from acute liver failure [1,2,3]. Dietary aflatoxin exposure is well documented in tropical climate zones such as sub-Saharan Africa and Southeast Asia. The distribution of aflatoxin-contaminated foods may extend to sub-tropical and even temperate climate zones, due to international food trade and climate change [4,5]
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