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Urugo MM, Teka TA, Lema TB, Lusweti JN, Djedjibegovíc J, Lachat C, Tesfamariam K, Mesfin A, Astatkie T, Abdel-Wahhab MA. Dietary aflatoxins exposure, environmental enteropathy, and their relation with childhood stunting. Int J Food Sci Nutr 2024; 75:241-254. [PMID: 38404064 DOI: 10.1080/09637486.2024.2314676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/30/2024] [Indexed: 02/27/2024]
Abstract
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.
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Affiliation(s)
- Markos Makiso Urugo
- Department of Food Science and Postharvest Technology, College of Agricultural Sciences, Wachemo University, Hosaina, Ethiopia
- Department of Postharvest Management, College of Agriculture and Veterinary Medicine, Jimma University, Jimma, Ethiopia
| | - Tilahun A Teka
- Department of Postharvest Management, College of Agriculture and Veterinary Medicine, Jimma University, Jimma, Ethiopia
| | - Tefera Belachew Lema
- Department of Nutrition and Dietetics, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | | | | | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Kokeb Tesfamariam
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
- Department of Public Health, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Addisalem Mesfin
- Center of Excellence in Mycotoxicology and Public Health, MYTOX-SOUTH, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
- Department of Human Nutrition, College of Agriculture, Hawassa University, Hawassa, Ethiopia
| | - Tess Astatkie
- Faculty of Agriculture, Dalhousie University, Truro, NS, Canada
| | - Mosaad A Abdel-Wahhab
- Food Toxicology & Contaminants Department, National Research Center, Dokki, Cairo, Egypt
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Mehta R, Wenndt AJ. Mycotoxins and bone growth: a review of the literature on associations between xenobiotic exposure and bone growth and development. Nutr Rev 2024:nuae032. [PMID: 38578611 DOI: 10.1093/nutrit/nuae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Mycotoxins are secondary metabolites of fungi that are known to be associated with linear growth faltering because of their impact on inflammation, intestinal damage, inhibition of protein synthesis, and micronutrient absorption. In this narrative review, we aim to extend this analysis to further explore associations between mycotoxins (aflatoxins, ochratoxins, trichothecenes including deoxynivalenol, T-2 toxin, and fumonisins) and long-bone growth, particularly during the saltatory periods of development. Linear growth is a direct function of skeletal development and long-bone growth. We therefore explored biological pathways and mechanisms of impact of these toxins in both animal and human studies, in addition to the epidemiology literature (post-2020). Given what is known of the effects of individual and combinations of mycotoxins based on the animal literature, we have identified a need for further research and examination of how these toxins and exposures may be studied in humans to elucidate the downstream impact on bone-related biomarkers and anthropometric indices used to identify and predict stunting in population-based studies.
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Affiliation(s)
- Rukshan Mehta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
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Nejad BG, Mostafaei Z, Rezaabad AB, Mehravar F, Zarei M, Dehghani A, Estabragh MAR, Karami-Mohajeri S, Alizadeh H. A systematic review with meta-analysis of the relation of aflatoxin B1 to growth impairment in infants/children. BMC Pediatr 2023; 23:614. [PMID: 38053136 PMCID: PMC10696779 DOI: 10.1186/s12887-023-04275-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/25/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Aflatoxins are regarded as the most potent genotoxic and carcinogenic type of mycotoxins. This meta-analysis was performed to investigate a the relation of aflatoxin B1 (AFB1) to growth measurements of infants/children, including wasting, underweight, stunting, as well as weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WHZ) z-scores. METHODS Electronic databases of PubMed, Web of Science, and Scopus were searched to identify related publications. Effect sizes for associations were pooled using the random effects analysis. Subgroup analysis by study design, method used to assess AFB1, and adjustment for covariateswas performed to detect possible sources of heterogeneity. RESULTS Pooled analysis of available data showed that AFB1 exposure was negatively associated growth z-scores, including WHZ (β = -0.02, 95%CI = -0.07 to 0.03), with WAZ (β = -0.18, 95%CI = -0.33 to -0.02), and HAZ (β = -0.17, 95%CI = -0.30 to -0.03) in infants/children. There was a remarkable heterogeneity among studies on WAZ and HAZ (P ≤ 0.001). In prospective cohort studies, AFB1 exposure was found to be significantly associated with the elevated risk of underweight (OR = 1.20, 95%CI = 1.03 to 1.40) and stunting (OR = 1.21, 95%CI = 1.11 to 1.33). CONCLUSIONS This meta-analysis highlighted the importance of AFB1 exposure as a potential risk factor for growth impairment in infants/children.
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Affiliation(s)
- Behnam Ghorbani Nejad
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Mostafaei
- Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Ali Balouchi Rezaabad
- Department of Pharmacognosy, School of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Mehravar
- Department of Psychiatry and Community Health Nursing School of Nursing and Midwifery, Golestan University of Medical Sciences (GOUMS), Golestan, Iran
| | - Mahtab Zarei
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Dehghani
- Nutrition Research Center, Department of Community Nutrition, Faculty of Nutrition and Food Science, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Somayyeh Karami-Mohajeri
- Pharmaceutics Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.
| | - Hamzeh Alizadeh
- Genetics Research Center, Department of Genetics and Breeding, The University of Guilan, Rasht, Iran.
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Cheng Q, Glesener H, Montenegro G, Torres O, Miller AC, Krajmalnik-Brown R, Rohloff P, Voth-Gaeddert LE. Assessment of aflatoxin exposure, growth faltering and the gut microbiome among children in rural Guatemala: protocol for an observational prospective cohort and bioreactor simulations. BMJ Paediatr Open 2023; 7:e001960. [PMID: 37080609 PMCID: PMC10124301 DOI: 10.1136/bmjpo-2023-001960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 04/22/2023] Open
Abstract
INTRODUCTION Aflatoxin B1 (AFB1) is a carcinogen produced by Aspergillus flavus and Aspergillus parasiticus which grow on maize. Given the high prevalence of child stunting (ie, impaired growth) and other nutritional disorders in low-income and middle-income countries, where maize is consumed, the role of aflatoxin exposure may be significant. Observational reports have demonstrated associations between aflatoxin exposure and impaired child growth; however, most have been cross-sectional and have not assessed seasonal variations in aflatoxin, food preparation and dynamic changes in growth. Biological mechanistic data on how aflatoxin may exert an impact on child growth is missing. This study incorporates a prospective cohort of children from rural Guatemala to assess (1) temporal associations between aflatoxin exposure and child growth and (2) possible mediation of the gut microbiome among aflatoxin exposure, inflammation and child growth. METHODS AND ANALYSIS We will prospectively evaluate aflatoxin exposure and height-for-age difference trajectories for 18 months in a cohort of 185 children aged 6-9 months at enrolment. We will assess aflatoxin exposure levels and biomarkers of gut and systemic inflammation. We will examine the faecal microbiome of each child and identify key species and metabolic pathways for differing AFB1 exposure levels and child growth trajectories. In parallel, we will use bioreactors, inoculated with faeces, to investigate the response of the gut microbiome to varying levels of AFB1 exposure. We will monitor key microbial metabolites and AFB1 biotransformation products to study nutrient metabolism and the impact of the gut microbiome on aflatoxin detoxification/metabolism. Finally, we will use path analysis to summarise the effect of aflatoxin exposure and the gut microbiome on child growth. ETHICS AND DISSEMINATION Ethics approval was obtained from Arizona State University Institutional Review Board (IRB; STUDY00016799) and Wuqu' Kawoq/Maya Health Alliance IRB (WK-2022-003). Findings will be disseminated in scientific presentations and peer-reviewed publications.
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Affiliation(s)
- Qiwen Cheng
- Biodesign Center for Health Through Microbiomes, Arizona State University, Tempe, Arizona, USA
| | - Hannah Glesener
- Biodesign Center for Health Through Microbiomes, Arizona State University, Tempe, Arizona, USA
| | - Gabriela Montenegro
- Center for Indigenous Health Research, Wuqu' Kawoq | Maya Health Alliance, Tecpan, Guatemala
| | - Olga Torres
- Centro de Investigaciones en Nutricion y Salud (CIENSA), Guatemala City, Guatemala
| | - Ann C Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Rosa Krajmalnik-Brown
- Biodesign Center for Health Through Microbiomes, Arizona State University, Tempe, Arizona, USA
| | - Peter Rohloff
- Center for Indigenous Health Research, Wuqu' Kawoq | Maya Health Alliance, Tecpan, Guatemala
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lee E Voth-Gaeddert
- Biodesign Center for Health Through Microbiomes, Arizona State University, Tempe, Arizona, USA
- Center for Indigenous Health Research, Wuqu' Kawoq | Maya Health Alliance, Tecpan, Guatemala
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Mahfuz M, Hossain MS, Alam MA, Gazi MA, Fahim SM, Nahar B, Ahmed T. Chronic Aflatoxin Exposure and Cognitive and Language Development in Young Children of Bangladesh: A Longitudinal Study. Toxins (Basel) 2022; 14:toxins14120855. [PMID: 36548752 PMCID: PMC9784379 DOI: 10.3390/toxins14120855] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Aflatoxin can cross the blood-brain barrier, damage brain tissues, and have the potential to harm the development of the human brain. Although dietary aflatoxin exposure is common in children, there is a paucity of data on aflatoxin exposure and child developmental outcomes. The child's cognitive, motor, and language functions were assessed using the Bayley Scales of Infant and Toddler Development-III or BSID-III at the same time points. Association between exposure to aflatoxin and subtests of BSID-III were examined using mixed-effect linear regression. Aflatoxin assays were performed on 194, 167, and 163 children at 15, 24, and 36 months of age, and chronic aflatoxin exposure was detected in 20.6%, 16.8%, and 60.7% of children, respectively. Multi-variable analyses showed that aflatoxin exposure was independently related to the children's cognitive score (β: -0.69; 95% CI: -1.36, -0.02), receptive language score (β: -0.90; 95% CI: -1.62, -0.17), and expressive language score (β: -1.01; 95% CI: -1.96, -0.05). We did not observe any association between exposure to aflatoxin and the motor function of children. Chronic exposure to aflatoxin exposure was linked to reduced cognitive, expressive, and receptive language scores of the study children. Further research is needed in a different setting to confirm this novel finding.
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Affiliation(s)
- Mustafa Mahfuz
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh
- Faculty of Medicine and Health Technology, University of Tampere, 3352 Tampere, Finland
| | - Md. Shabab Hossain
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh
| | - Md. Ashraful Alam
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh
- Correspondence:
| | - Md. Amran Gazi
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh
| | - Shah Mohammad Fahim
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh
| | - Baitun Nahar
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh
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Ashraf W, Rehman A, Ahmad MUD, Rabbani M, Mushtaq MH, Aamir K, Xue KS, Wang JS. Assessment of aflatoxin B 1-lysine adduct in children and its effect on child growth in Lahore, Pakistan. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2022; 39:1463-1473. [PMID: 35652855 DOI: 10.1080/19440049.2022.2080871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Aflatoxin B1 is an important toxic food contaminant and there is very little information available about its exposure and effects on the health of the Pakistani population. Therefore, children (n = 238) aged 1-11 years were recruited in this study to estimate the levels of aflatoxin B1-lysine adduct and to measure its adverse effects on growth. Blood samples were analyzed to detect AFB1-lysine adducts through high-performance liquid chromatography. Socio-demographic information and anthropometry measurements were also obtained. All participants had detectable levels of AFB1-lysine adduct with a median concentration of 10.66 pg/mg albumin (95% CI: 8.6-12.4). Differences in area of residence (p < 0.05) and the father's employment (p < 0.05) were significant predictors for aflatoxin concentration levels in ordinary least square and quantile regression models (residence in 75th quantile and father employment in 90th quantile). Children aged from 5 to 11 years in the 5th and 90th quantiles of the regression model had a significant association with aflatoxin levels. A very high (50.4%, 120/238) prevalence of growth impairment (stunting, wasting, and underweight) was also observed in this study. Although we couldn't establish the effect of aflatoxin on growth impairment, children with low serum albumin levels (OR = 0.18; 95% CI: 0.05-0.56; p = 0.004) were likely to be at risk of wasting. Also, low birth weight was strongly associated with wasting (OR = 3.11; 95% CI: 1.36-7.03; p = 0.006) and underweight (OR = 4.60; 95% CI: 2.21-10.05; p= <0.001), while the mother's school level education had a correlation with child stunting (OR = 1.84; 95% CI: 1.07-3.22; p = 0.029). The high prevalence of growth impairment and high concentration of serum AFB1-lysine adduct levels in study participants demand immediate efforts to mitigate the adverse health outcomes in children in Pakistan.
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Affiliation(s)
- Waseela Ashraf
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan.,Department of Environmental Health Science, The University of Georgia, Athens, GA, USA
| | - Abdul Rehman
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Mansur-Ud-Din Ahmad
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Masood Rabbani
- Institute of Microbiology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Hassan Mushtaq
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Khalida Aamir
- Department of Preventive Pediatric Medicine, The Children's Hospital and The Institute of Child Health, Lahore, Pakistan
| | - Kathy S Xue
- Department of Environmental Health Science, The University of Georgia, Athens, GA, USA
| | - Jia-Sheng Wang
- Department of Environmental Health Science, The University of Georgia, Athens, GA, USA
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Andrews‐Trevino J, Webb P, Shrestha R, Pokharel A, Acharya S, Chandyo R, Davis D, Baral K, Wang J, Xue K, Ghosh S. Exposure to multiple mycotoxins, environmental enteric dysfunction and child growth: Results from the AflaCohort Study in Banke, Nepal. MATERNAL & CHILD NUTRITION 2022; 18:e13315. [PMID: 35020261 PMCID: PMC8932698 DOI: 10.1111/mcn.13315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 12/07/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Johanna Andrews‐Trevino
- Division of Food and Nutrition Policy and Programs, Friedman School of Nutrition Science and Policy Tufts University Boston Massachusetts USA
| | - Patrick Webb
- Division of Food and Nutrition Policy and Programs, Friedman School of Nutrition Science and Policy Tufts University Boston Massachusetts USA
| | - Robin Shrestha
- Division of Food and Nutrition Policy and Programs, Friedman School of Nutrition Science and Policy Tufts University Boston Massachusetts USA
| | | | | | - Ram Chandyo
- Department of Community Medicine Kathmandu Medical College Kathmandu Nepal
| | - Dale Davis
- Helen Keller International‐Nepal Kathmandu Nepal
| | - Kedar Baral
- Department of Community Health Sciences Patan Academy of Health Sciences Lalitpur Nepal
| | - Jia‐Sheng Wang
- Department of Environmental Health Science University of Georgia Athens Georgia USA
| | - Kathy Xue
- Department of Environmental Health Science University of Georgia Athens Georgia USA
| | - Shibani Ghosh
- Division of Food and Nutrition Policy and Programs, Friedman School of Nutrition Science and Policy Tufts University Boston Massachusetts USA
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Tesfamariam K, Argaw A, Hanley-Cook GT, Gebreyesus SH, Kolsteren P, Belachew T, Van de Velde M, De Saeger S, De Boevre M, Lachat C. Multiple mycotoxin exposure during pregnancy and risks of adverse birth outcomes: a prospective cohort study in rural Ethiopia. ENVIRONMENT INTERNATIONAL 2022; 160:107052. [PMID: 34952355 DOI: 10.1016/j.envint.2021.107052] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Mycotoxin exposure during pregnancy has been associated with adverse birth outcomes in low- and middle-income countries. The evidence, however, is inconsistent and mainly limited to the assessment of a single mycotoxin. We assessed biomarkers of exposure to multiple mycotoxins during pregnancy and their associations with adverse birth outcomes in rural Ethiopia. METHODS We analyzed data from 579 pregnant women between 8 and 24 weeks of completed gestation enrolled in a prospective cohort study. Serum mycotoxin concentrations were determined using liquid chromatography coupled with tandem mass spectrometry. Multivariable linear probability models, adjusted for potential confounding factors and multiple comparisons, were fitted to assess the associations between mycotoxin exposure and small for gestational age and preterm birth. We applied principal component analysis to reduce the dimensionality of biomarker data from several taxonomic mycotoxin groups. RESULTS All pregnant women were co-exposed to at least five mycotoxins, and one pregnant woman was co-exposed to 27 mycotoxins. Fumonisins (FB), i.e., FB2, FB3, FB1, and tenuazonic acid were the most frequently identified mycotoxins in 98.8, 95.3, 93.3, and 81.4% of the samples respectively. Deoxynivalenol was detected in 38.7%, nivalenol in 50.1%, ochratoxin α in 67.9%, and zearalenone in 50.9% of the serum samples. After adjustment, we found no statistically significant (all P ≥ 0.05) associations between mycotoxin exposures and birth outcomes. CONCLUSIONS Despite our study providing no evidence for relationships between mycotoxin biomarkers and adverse birth outcomes, our findings do indicate an extensive presence of multiple mycotoxin exposure among pregnant women. Public health policies and nutrition-sensitive interventions must ensure exposure to mycotoxins is reduced in rural Ethiopia.
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Affiliation(s)
- Kokeb Tesfamariam
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium; Department of Public Health, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia; Center of Excellence in Mycotoxicology and Public Health, Faculty of Pharmaceutical Sciences, Ghent University, MYTOX-SOUTH® Coordination Unit, Ghent, Belgium; Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Alemayehu Argaw
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium; Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Giles T Hanley-Cook
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Seifu H Gebreyesus
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Tefera Belachew
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Mario Van de Velde
- Center of Excellence in Mycotoxicology and Public Health, Faculty of Pharmaceutical Sciences, Ghent University, MYTOX-SOUTH® Coordination Unit, Ghent, Belgium
| | - Sarah De Saeger
- Center of Excellence in Mycotoxicology and Public Health, Faculty of Pharmaceutical Sciences, Ghent University, MYTOX-SOUTH® Coordination Unit, Ghent, Belgium; Department of Biotechnology and Food Technology, Faculty of Science, University of Johannesburg, Doornfontein Campus, Gauteng, South Africa
| | - Marthe De Boevre
- Center of Excellence in Mycotoxicology and Public Health, Faculty of Pharmaceutical Sciences, Ghent University, MYTOX-SOUTH® Coordination Unit, Ghent, Belgium
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium.
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9
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Smith JW, Matchado AJ, Wu LSF, Arnold CD, Burke SM, Maleta KM, Ashorn P, Stewart CP, Shaikh S, Ali H, Labrique AB, West KP, Christian P, Dewey KG, Groopman JD, Schulze KJ. Longitudinal Assessment of Prenatal, Perinatal, and Early-Life Aflatoxin B 1 Exposure in 828 Mother-Child Dyads from Bangladesh and Malawi. Curr Dev Nutr 2022; 6:nzab153. [PMID: 35155983 PMCID: PMC8829025 DOI: 10.1093/cdn/nzab153] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/14/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Joshua W Smith
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Andrew J Matchado
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, Davis, CA, USA
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Lee S-F Wu
- Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Charles D Arnold
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, Davis, CA, USA
| | - Sean M Burke
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kenneth M Maleta
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Per Ashorn
- Tampere University, Faculty of Medicine and Health Technology, Center for Child, Adolescent and Maternal Health Research and Tampere University Hospital, Department of Pediatrics, Tampere, Finland
| | - Christine P Stewart
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, Davis, CA, USA
| | - Saijuddin Shaikh
- Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh
| | - Hasmot Ali
- Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- The JiVitA Project of Johns Hopkins University, Bangladesh, Gaibandha, Bangladesh
| | - Alain B Labrique
- Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Keith P West
- Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kathryn G Dewey
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, Davis, CA, USA
| | - John D Groopman
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kerry J Schulze
- Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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10
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Phillips E, Turner P, Ngure F, Kassim N, Makule E, Smith L, Nelson R, Stoltzfus R. Ethical considerations in the design and conduct of a cluster-randomised mycotoxin mitigation trial in Tanzania. WORLD MYCOTOXIN J 2022. [DOI: 10.3920/wmj2021.2705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Aflatoxins are fungal metabolites that commonly contaminate staple food crops in tropical regions. Acute aflatoxin consumption in very high concentration causes aflatoxicosis and acute liver failure, while chronic, moderate levels of intake cause hepatocellular carcinoma. The effects of frequent moderate- to high-level exposure during infancy, however, is less clearly understood. Half a billion people in low- and middle-income countries continue to be exposed to aflatoxins through dietary consumption, in part because of lack of enforcement of regulatory limits and few feasible long-term mitigation options in these settings. Several epidemiologic studies have shown an association between aflatoxin exposure in infants and young children and growth failure, but strong experimental evidence is lacking. The Mycotoxin Mitigation Trial conducted in Tanzania was a cluster-randomised trial to assess the effect of a reduced aflatoxin diet on linear growth. Prior to the design and implementation of this trial, a group of multi-disciplinary and multi-national scientists reviewed literature in biomedical, public health, environmental health ethics. In this paper we outline the most salient ethical questions and dilemmas in the potential conduct of such a study and describe the ethical precedents and principles that informed our decision-making processes and ultimate study protocol.
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Affiliation(s)
- E. Phillips
- Division of Nutritional Sciences, Cornell University, 244 Garden, Ithaca, NY 14853, USA
| | - P.C. Turner
- MIAEH, School of Public Health, University of Maryland, College Park, MD 20740, USA
| | - F.M. Ngure
- Independent Research Consultant, Arusha, Tanzania and Nairobi, Kenya
| | - N. Kassim
- Department of Food Biotechnology and Nutritional Sciences, (FBNS), School of Life Science and Bio-Engineering, The Nelson Mandela African Institution of Science and Technology (NM-AIST), P.O. Box 447, Arusha, Tanzania
| | - E. Makule
- Department of Food Biotechnology and Nutritional Sciences, (FBNS), School of Life Science and Bio-Engineering, The Nelson Mandela African Institution of Science and Technology (NM-AIST), P.O. Box 447, Arusha, Tanzania
| | - L.E. Smith
- Department of Population Medicine and Diagnostics, Cornell University, Ithaca, NY 14853, USA
| | - R.J. Nelson
- School of Integrative Plant Science and Department of Global Development, Cornell University, Ithaca, NY 14853, USA
| | - R.J. Stoltzfus
- Goshen College, 1700 S. Main Street, Goshen, Indiana 46526, USA
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