Aflatoxin exposure in children living in Mirpur, Dhaka: data from MAL-ED companion study

Mustafa Mahfuz,Md Amran Gazi,Muttaquina Hossain,John D Groopman,Shah Mohammad Fahim,Mohammed Ashraful Alam,Patricia A Egner,Tahmeed Ahmed,Mohammad Jyoti Raihan,Pascal Obong Bessong,William A Petri

doi:10.1038/s41370-018-0066-5

Abstract

Dietary exposure to aflatoxin is implicated in growth faltering of children. Despite the high burden of childhood stunting in urban Bangladesh, there are no data on long-term exposure to aflatoxin. This study aimed to explore aflatoxin exposure levels in a group of children followed longitudinally. The current study used data and biospecimens collected during 2010–2014 as part of the MAL-ED birth cohort study in an urban slum of Mirpur, Dhaka where children were followed from birth to 36 months. AFB1-lysine adduct concentrations were determined by isotope dilution mass spectrometry from plasma samples collected at 7, 15, 24, and 36 months of age. The limit of detection was 0.5 pg of AFB1-lys/mg albumin. In 744 plasma samples, the geometric mean of AFB1-lysine/mg albumin was 1.07 pg (range 0.04–123.5 pg/mg albumin). The proportion of children with detectable aflatoxin exposure was 10.1, 20.9, 17.9, and 61.7% for 7, 15, 24, and 36 months, respectively. Reduction in breastfeeding prevalence (80% at 24 months vs. 38% in 36 months) corresponded with the high-level detection of AFB1-lysine at the age of 36 months. AFB1-lysine concentrations were the highest at the end of monsoon. This study reveals that 62% of children in slum settlement were exposed to aflatoxin by the end of the third year of life. High aflatoxin exposure was detected at the end of rainy season and with the introduction of family food. These findings suggest interventions to ameliorate the problem of chronic aflatoxin exposure including childhood stunting.

Highlights

Linear growth faltering in children is a pervasive public health burden for low- and middle-income countries globally, and it is a consequence of a wide variety of factors such as undernutrition, poor hygiene, low socioeconomic status, local political instability, and repeated episodes of infectious diseases [1]
Childhood stunting is highly prevalent in South and East Asia, as well as Sub-Saharan Africa where food-borne aflatoxin exposure is high [2]
Given the high burden of childhood stunting, there are no data on long-term exposure to aflatoxin as measured by aflatoxin B1-lysine (AFB1-lys) adduct in plasma samples from children in urban Bangladesh

Summary

Introduction

Linear growth faltering in children is a pervasive public health burden for low- and middle-income countries globally, and it is a consequence of a wide variety of factors such as undernutrition, poor hygiene, low socioeconomic status, local political instability, and repeated episodes of infectious diseases [1]. In addition to the widely recognized risk factors, dietary and environmental toxins may have a potential role in childhood stunting [2, 3]. Reports from Sub-Saharan Africa have implicated aflatoxin exposure with stunting among children [2, 4,5,6]. Childhood stunting is highly prevalent in South and East Asia, as well as Sub-Saharan Africa where food-borne aflatoxin exposure is high [2]. Bangladesh has one of the highest prevalence rates of childhood stunting in the world. About 36% of children under the age of 5 years in Bangladesh are stunted or short for their age, while 15% are reported to be severely stunted [7]

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