A worldwide systematic literature review for aflatoxin M1 in infant formula milk: Human health risk assessment by Monte Carlo simulation

Comparison of fluoride level between mother's milk and infant formula milk - a global systematic review and dental fluorosis risk assessment

Dental Fluorosis (DF) is one of the negative outcomes of excessive fluoride (F) intake through food sources. This systematic review aimed to compare F content in two important food sources for infants, Mother's Milk (MoM) and Infant Formula (IF), and then evaluate the risk of DF related to F in those two types of food. For this purpose, 181 studies were initially found by searching the relevant keywords in widely recognized databases, including Google Scholar, Scopus, Science Direct, and PubMed. Then, 29 final studies were selected considering the inclusion and exclusion criteria. The results showed that the F level of MoM in five out of nine (55.5%) studies and its overall average worldwide does not comply with the European Food Safety Authority (EFSA) guideline (100 µg/L). Therefore, MoM's value of F must be continuously monitored, and risk mitigation solutions must be used to reduce F. Accordingly, tracking F in drinking water, tea, and food consumed by lactating mothers (LMs) was the essential measure that could lead to the reduction of F of MoM. The level of F of IF was much lower than its value in MoM. The estimated hazard quotient (HQ) of DF for both types of food was lower than the acceptable level (HQ = 1), but, due to other sources of F intake, it is necessary to use control solutions to reduce the level of F in MoM and IF consumed by infants.

Infant nutrition at risk: a global systematic review of ochratoxin A in human breast milk-human health risk assessment

Human breast milk is the optimal source of nutrition for newborns, but the potential transfer of contaminants like mycotoxins, particularly ochratoxin A (OTA), from maternal blood to milk remains a concern. This systematic review aims to provide a comprehensive analysis of global OTA levels in human breast milk and assess the associated health risks. We conducted a thorough search of scientific databases, including Web of Science, ScienceDirect, Scopus, Google Scholar and PubMed, using keywords related to OTA in human breast milk. A total of 39 studies met the inclusion criteria for this review. OTA levels compared to limits, estimated infant intake at various ages and health risks assessed using Margin of Exposures (MOEs) and Hazard quotient (HQ). Our findings reveal the widespread presence of OTA in breast milk across different regions, with notably higher levels detected in Africa compared to Asia, South America and Europe. The higher concentrations observed in warmer, humid climates suggest that environmental factors significantly influence OTA contamination. Mature breast milk samples generally exhibited greater OTA exposure. The neoplastic and non-neoplastic effects demonstrate generally low risks globally. The regional differences in OTA levels and associated health risk assessments underscore the need for continued research into the health impacts of OTA exposure in infants. This includes further investigation into multiple sources of exposure, such as infant formula, within the broader context of the exposome framework.

Stochastic health risk assessment of aflatoxin M1 in cow's milk among Lebanese population

This study quantitatively assessed AFM1 exposure through consumption of cows' milk in Lebanese adolescents and adults. Lebanon-specific, non-aggregated data on (i) milk intake and body weight - from an existing survey for adults and from a new survey for adolescents, and (ii) AFM1 occurrence in milk, were fitted to distributions and incorporated into a probabilistic model. Risk of hepatocellular carcinoma (HCC) for milk consumers was estimated considering the incidence of hepatitis B virus in Lebanon and characterized using the margin of exposure (MOE). All subgroups' mean risk estimates, expressed as additional HCC cases per 100 000 population per year, were significantly different (p < 0.05), and ranged from 2.2x10-4 for adult males to 4.9x10-4 for adolescent males. This variation is attributed to significant differences in body weight and milk intake. MOE identified adolescent males and females as at-risk populations (mean 9628 and 8108, respectively). For adults, levels of concern were only reached with extreme consumption and/or contamination events. Considering that exposure from other sources (e.g., dairy) is cumulative, control of AFM1 in milk in Lebanon should be a risk management priority to ensure protection of younger populations.

Ochratoxin a levels in Turkish coffee: a probabilistic health risk assessment via Monte Carlo simulation

Throughout history, Turkish coffee has been the most widely consumed type of coffee in Turkey. Therefore, the goal of this study was to determine the amount of ochratoxin A (OTA) present in Turkish coffee and to analyze any potential health hazards. A total of 41 Turkish coffees were collected and analyzed for OTA activity using a competitive enzyme immunoassay (ELISA). Furthermore, dietary exposure and health risk assessments for the Turkish population were calculated based on analytical results and coffee consumption data from the Turkish Nutrition and Health Survey 2019 (TNHS-2019) in three age categories (15-18, 19-64, and 65 + years). Nine of the samples contained more than 2.5 μg/kg OTA, with an average of 5.24 μg/kg. The OTA concentration in 3 samples exceeded the permissible maximum limit (5 μg/kg) established by Turkish legislation, and the mean concentration was 8.41 μg/kg. A margin of exposure (MOE) approach was used for risk characterization, considering both non-neoplastic and neoplastic consequences. There were no concerns about health risks because MOEs were more than 10,000 for all categories. Although the levels of OTA analyzed in Turkish coffee did not pose a risk to individuals in the three age categories, emphasis should be placed on minimizing and controlling OTA concentrations in Turkish coffee. Additionally, it is also necessary to consider other food sources that could contribute to OTA exposure.

Human health risk assessment of potentially toxic and essential elements in medicinal plants consumed in Zabol, Iran, using the Monte Carlo simulation method

Medicinal plants (MPs) have long been used for their therapeutic properties in traditional forms of medicine. However, the presence of potentially toxic elements (PTEs) in MPs raises concerns about their safety, efficacy, and potential adverse effects on human health. The current study aimed to determine the level of potentially toxic and essential elements (PTEEs) in commonly consumed MPs in Zabol, Iran, along with their health risk assessments. To conduct the present study, 10 types of MPs widely used in Zabol, Iran, were selected, and 15 samples of each type (150 samples in total) were taken. Each sample was analyzed for the presence of various PTEEs using Inductively Coupled Plasma Optical Emission Spectroscopy (ICP-OES) for Lead (Pb), cadmium (Cd), chrome (Cr), nickel (Ni), copper (Cu), zinc (Zn), iron (Fe), aluminum (Al) and manganese (Mn); and Atomic Absorption Spectrometry (AAS) for arsenic (As) and mercury (Hg). Finally, to better comprehend the scope of exposure and its possible effects, the Monte Carlo simulation method is successfully applied to assess human health risks related to PTEs in MPs. Statistical analysis revealed statistically significant (P < 0.001) variations in PTE averages among MP types. Furthermore, all samples' overall PTE mean concentration (range: 0.18 to 215.5 µg/kg) was below the World Health Organization's (WHO) regulatory standards. Probabilistic health risks, including non-carcinogenic-target hazard quotient (THQ) for each element, total target hazard quotient (TTHQ) for all elements, and carcinogenic-incremental lifetime cancer risk (ILCR) for each element, and total carcinogenic risk (TCR) for all elements, were significantly lower than the acceptable limit for children and adults. Accordingly, it can be said that consuming MPs sold in Zabol is safe for children and adults regarding carcinogenic (ILCR/TCR = 10- 4) and non-carcinogenic (THQ/TTHQ = 1) effects. In light of the findings presented here, and to our understanding, the primary factor contributing to lower levels of PTEs in MPs in Zabol City markets is the cultivation of plants in nonindustrialized areas, separate from urban and industrial zones. This practice keeps them from environmental contaminations, including soil quality and water sources. It is recommended that it is essential to regulate the sources that enhance the transfer of PTEs and other harmful pollutants from surroundings to the soil and, consequently, MPs. It is also suggested that, like chemical drugs, MPs should undergo rigorous testing by quality control agencies before being made available to the market.

Occurrence, evaluation, and human health risk assessment of ochratoxin a in infant formula and cereal-based baby food: a global literature systematic review

This study reviews global levels of ochratoxin A (OTA) in infant formula and cereal-based foods, using Monte Carlo simulation to assess risks. The review found 24 studies on global OTA levels in infant food and cereal-based products, using databases including PubMed, Scopus, Web of Science and Embase until March 2024. We estimated OTA exposure in infant food based on concentration, intake and body weight. The exposure and hazard quotient margin were calculated using BMDL10 and TDI values. Monte Carlo simulation evaluated human health risks from OTA in infant formula and cereal-based foods. A global study from 14 countries shows varying levels, surpassing EU limits in Tunisia, Ecuador, the USA, and generally in Africa, notably in infant cereals, which had higher levels than formula. Globally, OTA was present in 29.3% of the 3348 samples analyzed, with Lebanon at 95.2% and Brazil at 0%. Analysis indicates only non-carcinogenic risk for infants. While health risks for infants are mostly low, ongoing research and monitoring are vital to minimize OTA exposure in infant food.

Dietary Exposure and Risk Assessment of Multi-Mycotoxins (AFB1, AFM1, OTA, OTB, DON, T-2 and HT-2) in the Lebanese Food Basket Consumed by Adults: Findings from the Updated Lebanese National Consumption Survey through a Total Diet Study Approach

Mycotoxins have been linked to adverse health impacts, including liver cancer and kidney diseases. The objectives of the current study were to evaluate the dietary exposure of Lebanese adults to multi-mycotoxins (aflatoxin B1 (AFB1), aflatoxin M1 (AFM1), ochratoxin A (OTA), ochratoxin B (OTB), deoxynivalenol (DON), T-2 and HT-2) and to assess their associated health risks. Hence, a nationally representative sample of 449 participants aged 18-64 years old were interviewed to obtain their socio-demographic characteristics, food consumption data and exposure estimates. A food frequency questionnaire and 24 h-recall were used to collect data. The concentration of mycotoxins in all foods consumed by the participants was collected from previous national published studies. The estimated daily intake (EDI), the hazard quotient (HQ) and the margin of exposure (MOE) were calculated. The total exposure to AFB1, AFM1, OTA and DON was 1.26, 0.39, 4.10 and 411.18 ng/kg bw/day, respectively. The MOE to AFB1, AFM1, OTA and DON in the Lebanese food basket was 316, 1454, 3539 and 510, respectively, indicating high health-related risks. Per food items, the MOE to AFB1 was below 10,000 in cereals (466.5), mainly in rice (827.9) and Burgul (4868.5). Similarly, the MOE to OTA in cereals was 1439, in which bread (4022), rice (7589) and bulgur (7628) were considered unsafe. Moreover, the MOE to DON in cereals (605) is alarming, especially in bread (632) and manakesh (6879). The MOE to AFM1 in dairy products was 1454, indicating health-related risks with a focus on yogurt (9788) and labneh (8153). As for the herbs/spices group and traditional dishes, the MOE to AFB1 was relatively lower than 10,000 (3690 and 1625, respectively), with a focus on thyme (2624) and kishik (3297), respectively. It is noteworthy that the MOE to DON and the MOE to OTA in traditional foods and coffee were lower than 10,000 (8047 and 8867, respectively). All hazard quotient (HQ) values were below 1, except the HQ value of milk and dairy products (1.96). The intake of some food groups varied between age categories, corresponding to differences in EDI between them. Thus, it is essential to put control measures in place to decrease the contamination and exposure to mycotoxins by Lebanese consumers.

A national systematic literature review for aflatoxin M1 in commonly consumed cheese brands in Iran: Human health risk assessment by Monte Carlo simulation

Cheese is popular in Iran because of its high nutritional value; therefore, it is necessary to control this product regarding health risk factors, particularly aflatoxin M1 (AFM1). This research reviewed AFM1 in various varieties of cheese in Iran to assess the potential health risks associated with consuming these products for different age groups. In this regard, all accessible papers from different databases were screened between June 27, 2000 and October 10, 2022 b y systematic research and then considering the selection criteria of the studies; finally, 22 articles were selected for the current review. The amount and prevalence of AFM1 were calculated and separated based on the cheese variety, and the sampling location; health risk assessment (HRA), statistical, uncertainty, and sensitivity analysis for AFM1 of cheese for different age groups were performed. The study results for 2143 samples showed that the overall average AFM1 for cheese is 160 ± 175 ng/kg, below the European Commission (EC) regulation (250 ng/kg). AFM1 contaminated 72.42% of all cheese samples, and 13% of these contaminated samples had a higher AFM1 than the EC regulation. Cheese varieties were ranked based on average levels of AFM1 as white pasteurized > traditional > creamy > probiotic > Lighvan, and this ranking was obtained based on sampling locations as market > dairy factories > livestock farms. Based on the HRAs, from the perspective of the liver cancer risk (LCR), the margin of exposure (MOE), and the hazard index (HI) approach, it can be concluded that cheese produced in Iran, in terms of AFM1, particularly for children, poses serious health risks. Accordingly, it is imperative to carefully consider implementing suitable management methods to inhibit the growth of aflatoxin B1 (AFB1) in livestock fodder, and training in sanitary production and processing of dairy products according to world standards is suggested for industrial and traditional cheese producers across Iran.

Extraction and determination of aflatoxin B1 in cereal samples using pH-switchable hydrophobic deep eutectic solvents followed by HPLC-FL analysis

A quick, simple and environmentally friendly liquid phase microextraction (LPME) sample pretreatment procedure was proposed based on pH-switchable hydrophobic deep eutectic solvents (HDESs) and high performance liquid chromatography coupled with a fluorescence detector (HPLC-FL). This method was used for the quantitative study of aflatoxin B1 (AFB1) and applied to eight widely consumed cereal samples. In this method, six different DESs were synthesized and then their pH-switchability was investigated. DESs that could be switched with pH were employed for separation and preconcentration of AFB1 in cereal samples. In this method, dispersing the extractant phase in the aqueous solution and subsequent phase separation are performed only by changing the pH. Important parameters affecting extraction, such as the type of DES and its volume, concentration of KOH, volume of HCL, effect of salt and extraction time were investigated and optimum conditions were obtained. Under the optimum conditions, relative standard deviation (RSD) values for intra-day and inter-day of the method based on seven replicate measurements of 5.0 μg kg-1 of AFB1 in cereal samples were 3.3 and 5.2%, respectively. The calibration graphs were linear in the range of 0.007-20 μg kg-1 and limit of detection (LOD) was 0.002 μg kg-1. The relative recoveries of real cereal samples which have been spiked with different levels of AFB1 were 90.8-107.5%.

Effects of chronic low-dose aflatoxin B1 exposure in lactating Florida dairy goats

In the past few years there has been a growing trend in the prevalence of aflatoxins, attributable to climate change, in substances destined for animal feeding, together with an increase in dairy product consumption. These facts have triggered great concern in the scientific community over milk pollution by aflatoxin M₁. Therefore, our study aimed to determine the transfer of aflatoxin B₁ from the diet into milk as AFM₁ in goats exposed to different concentrations of AFB₁, and its possible effect on the production and serological parameters of this species. For this purpose, 18 goats in late lactation were divided into 3 groups (n = 6) and exposed to different daily doses of aflatoxin B₁ (T1 = 120 µg; T2 = 60 µg, and control = 0 µg), during 31 d. Pure aflatoxin B₁ was administered 6 h before each milking in an artificially contaminated pellet. The milk samples were taken individually in sequential samples. Milk yield and feed intake were recorded daily, and a blood sample was extracted on the last day of exposure. No aflatoxin M₁ was detected, either in the samples taken before the first administration, or in the control group ones. The aflatoxin M₁ concentration detected in the milk (T1 = 0.075 µg/kg; T2 = 0.035 µg/kg) increased significantly on a par with the amount of aflatoxin B₁ ingested. The amount of aflatoxin B₁ ingested did not have any influence on aflatoxin M₁ carryover (T1 = 0.066% and T2 = 0.060%), these being considerably lower than those described in dairy goats. Thus, we concluded that the concentration of aflatoxin M₁ in milk follows a linear relationship with respect to the aflatoxin B₁ ingested, and that the aflatoxin M₁ carryover was not affected by the administration of different aflatoxin B₁ doses. Similarly, no significant changes in the production parameters after chronic exposure to aflatoxin B₁ were observed, revealing a certain resistance of the goat to the possible effects of that aflatoxin.

Human Health Risk Assessment and Exposure Evaluation by Monte-Carlo Simulation Method for Aflatoxin M1 in Widely Consumed Infant Dried Powder Milk in Iran

Monitoring aflatoxin M1 (AFM1) in dairy products and milk-based foods is very important. The main purpose of this research was to investigate and determine the amount and human health risk assessment of aflatoxin M1 (AFM1) in the most famous and widely used brands of infant dried powder milk (IDPM) consumed in Iran. For this study, 45 imported IDPM (IM-IDPM) samples and 45 domestically produced IDPM (DO-IDPM) samples (a total of 90 samples) were selected randomly. All samples were analyzed for AFM1 using a competitive enzyme-linked immunosorbent assay (ELISA) technique. The mean level and the percentage of positive samples for AFM1 in DO-IDPM were 9.2 ± 5.4 ng/kg and 73.3%, and for IM-IDPM, they were 5.1 ± 3.8 ng/kg and 33.3%, respectively. The average level of AFM1 in all samples was lower than the EU and Iranian national standards (25 ng/kg). AFM1 intake through IDPM consumption by Iranian infants less than one-year-old was lower than the allowable level, but the hazard quotient for infants less than 6 months was higher than the allowable level. Although the concentration of AFM1 in IDPM consumed in Iran is not hazardous, since Iranian infants may be exposed to AFM1 through other sources, including baby food, breast milk, raw and pasteurized milk, continuous monitoring of IDMP quality in Iranian markets should be taken.

Promising instrument-free detections of various analytes using smartphones with Spotxel® Reader

In consideration of the problems related to food safety, environmental pollution, and the spread of infected diseases nowadays, we urgently need testing methods that can be easily performed by common people. Smartphone-based detections are promising for general applications. However, some of these analytical strategies require a combination of accessories and instruments, such as portable electrochemical workstations, mini multi-mode microplate readers, and complex temperature control devices, etc., which are small but still expensive. Herein, we comprehensively introduce a free app (Spotxel^® Reader) that can provide accurate data analysis for microplate or parallel-format test sensors without an instrument. By simulating the optical signal of the test samples through a smartphone, the sensing results can be obtained for free. We discuss the detection strategies involved in the reported smartphone-based analyses using Spotxel^® Reader. Prospects for the development of this free app for future detection applications are presented. This review aims to popularize free analysis software, so that ordinary people may realize convenient tests.

Aptamer against Aflatoxin B1 Obtained by SELEX and Applied in Detection

Aflatoxins, especially aflatoxin B1 (AFB1), are the most prevalent mycotoxins in nature. They contaminate various crops and cause global food and feed safety concerns. Therefore, a simple, rapid, sensitive, and specific AFB1 detection tool is urgently needed. Aptamers generated by SELEX technology can specifically bind the desired targets with high affinity. The broad range of targets expands the scope of applications for aptamers. We used an AFB1-immobilized magnetic nanoparticle for SELEX to select AFB1-specific aptamers. One aptamer, fl-2CS1, revealed a dissociation constant (Kd = 2.5 μM) with AFB1 determined by isothermal titration calorimetry. Furthermore, no interaction was shown with other toxins (AFB2, AFG1, AFG2, OTA, and FB1). According to structural prediction and analysis, we identified a short version of the AFB1-specific aptamer, fl-2CS1/core, with a minimum length of 39-mer used in the AFB1-aptasensor system by real-time qPCR. The aptasensor showed a broad range of detection from 50 ppt to 50 ppb with an accuracy of 90% in the spiked peanut extract samples. With the application of the AFB1-aptasensor we have constructed, a wide range detection tool with high accuracy might be developed as a point-of-care testing tool in agriculture.

Quantitative analysis and carcinogenic/non-carcinogenic risk assessment of aflatoxin M1 in milk-based baby food and infant formula milk - a case study in Iran

In this study, solid-phase extraction (SPE) combined with the dispersive liquid-liquid microextraction based on novel hydrophobic deep eutectic solvent (DLLME - DES) has been developed as an ultra-pre-concentration technique for the extraction of aflatoxin M₁ (AFM1) in milk-based baby food (MBBF) and infant formula milk (IFM) samples followed by HPLC combined with fluorescence detection (HPLC - FL). In addition, carcinogenic and non-carcinogenic risk assessment was performed by health-related risk factors including liver cancer risk (LCR), margin of exposure (MOE) and target hazard quotient (THQ) were calculated using the mean of AFM1 in different infant food samples. The results of the study showed that the mean of AFM1 was statistically significant different between various brands and types of IFM and MBBF. The results of the study showed that the percentage of positive samples higher than the allowable limit of AFM1 in 36 samples of domestic infant formula milk (DIFM), 24 samples of imported infant formula milk (IIFM), 36 samples of domestic milk-based baby food (DMBBF) and 18 samples of imported milk-based baby food (IMBBF) were 41.6, 12.5, 66.7 and 33.3%, respectively. In addition, estimated values for health risk-related factors including LCR, MOE and THQ indicated that for most infants less than one-year-old were higher than the acceptable levels. Based on the results, it can be concluded that the quality of IFM and MBBF consumed in Iran in terms of AFM1 is poor. Therefore, it is necessary to take appropriate measures to reduce the amount of AFM1 in DIFM and DMBBF, and in addition, the IIFM and IMBBF should be controlled qualitatively before supplying the market.

Decrease in Aflatoxin M1 Concentration in Milk during Cholesterol Removal by Application of β-Cyclodextrin

Approximately one-third of humankind is chronically exposed to the carcinogenic aflatoxin M1 contained in milk. As β-cyclodextrin is frequently used in the food industry, its effect on aflatoxin M1 concentration was investigated during cholesterol removal from milk due to the similarity among the physicochemical properties of aflatoxin M1 and cholesterol. Moreover, the elimination of cholesterol using β-cyclodextrin has been successfully applied in many studies without any substantial effect on the quality of the treated milk. Therefore, milk samples were spiked with aflatoxin M1 within the range from 0.20 to 2.00 µg/kg, and cholesterol removal was carried out by 2.0% (w/w) β-cyclodextrin addition, as this concentration is enough for the sufficient removal of cholesterol. It was found that the mean cholesterol concentration decreased by 92.3%, while the aflatoxin M1 concentration decreased to 0.53 ± 0.04 µg/kg, i.e., by 39.1% after treatment (n = 2). This mitigation procedure itself is easy and inexpensive and thus is fully applicable with a high potential for complete decontamination of aflatoxin M1 milk. This method will therefore considerably improve the food safety issues associated with aflatoxin M1 presence in milk and dairy products.

Aflatoxin B1 Occurrence in Children under the Age of Five's Food Products and Aflatoxin M1 Exposure Assessment and Risk Characterization of Arab Infants through Consumption of Infant Powdered Formula: A Lebanese Experience

Aflatoxin M1 (AFM1) is a salient metabolite that can be used to assess Aflatoxin B₁ (AFB1) exposure in humans and animals. The carcinogenic potency of AFB1 and AFM1 was severely reported. The aims of this study were (1) to survey the contamination level of AFM1 in the most traded infant powdered formula brands (IPF) (n = 42) along with the AFB1 level in under 5's children food brands (biscuits, cornflakes, and cereals) (n = 42) and (2) to assess the estimated daily intake (EDI), the hazard quotient (HQ) and the margin of exposure (MOE) of AFM1 among infants (0-12 months) in Lebanon. All of the samples were analyzed using ELISA technique. AFB1 was below detection limit in all of the children's food brands samples. Out of 42 IPF samples 9.5% were AFM1-positive in the range of 29.54-140.16 ng/L and exceeded the maximum tolerable limit (MTL) set by the European commission (25 ng/kg). The overall average contamination level was 5.72 ± 0.014 ng/L. The EDI of AMF1 for male was in the range of 0.37-0.78 ng/kg/b.w./day and 0.40-0.87 ng/kg/b.w./day for females. Similarly, the HQ calculation resulted in an average of 3.05 for males and 3.28 for females. MOE calculations were far lower from 10,000 in both genders which indicates a high risk of genotoxicity and carcinogenicity. Our findings show that AFM1's EDI, HQ and MOE scored high among Lebanese infants. As infants consume more IPF relative to their body weight, the persistence of IPF with high AFM1 levels threatens their health. Thus, infant's exposure risk to AFM1 in IPF should be a continuous focus of attention.