Exposure Assessment and Risk Characterization of Aflatoxin M1 Intake through Consumption of Milk and Yoghurt by Student Population in Serbia and Greece

Spatial Distribution and Dietary Risk Assessment of Aflatoxins in Raw Milk and Dairy Feedstuff Samples from Different Climate Zones in China

This study aimed to explore the contamination of aflatoxins by investigating the spatial distribution of aflatoxin B1 (AFB1) in cow feedstuff and aflatoxin M1 (AFM1) in raw milk, and the potential health risks of AFM1 in milk and dairy products. Feedstuff and raw milk were collected from 160 pastures in three climate zones of China from October to November 2020. The results indicated the level of AFB1 and AFM1 ranged from 51.1 to 74.1 ng/kg and 3.0 to 7.0 ng/kg, respectively. Spatial analysis indicated the contamination was mostly concentrated in the temperate monsoon climate zone. On average, the estimated dietary exposure to AFM1 from milk and dairy products for Chinese consumers ranged from 0.0138 to 0.0281 ng/kg bw/day, with the MOE values below 10,000, and liver cancer risk of 0.00004-0.00009 cases/100,000 persons/year. For different groups, the average exposure to AFM1 was highest in the temperate monsoon climate zone and for toddlers.

Aflatoxins in maize, milk and dairy products from Serbia

This study presents data on the occurrence of aflatoxins B1, B2, G1 and G2 in maize and aflatoxin M1 (AFM1) in milk and dairy products from Serbia in 2022. A total of 100 maize samples were analysed using liquid chromatography tandem mass spectrometry, while 107 cow and goat milk, besides dairy products were tested with an ELISA method. Aflatoxins contaminated 78% of the maize samples, with aflatoxin B1 as the most prevalent aflatoxin, also at the highest determined level. All milk samples tested positive for AFM1, while contamination in dairy products ranged from 14% to 100%. The hot and dry weather during the 2022 maize growing season, characterised by moderate to extreme drought conditions, significantly increased maize contamination with aflatoxins, impacting subsequent milk and dairy products contamination. The findings of this study confirm the continuous trend and persistent challenge in Serbia concerning the prevalence of aflatoxins in maize and milk, closely linked to climate change.

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.

Risk Assessment of AFM1 in Raw Milk and Dairy Products Produced in Armenia, a Caucasus Region Country: A Pilot Study

This paper presents the first assessment of dietary exposure to aflatoxin M1 (AFM1) and associated health risks through milk and dairy product consumption in Armenia. Data on AFM1 in raw milk were obtained from an annual residue monitoring program. Additionally, commonly consumed dairy products (pasteurized milk, cheese, sour cream, curd cheese) were sampled, considering the sources of raw milk used by dairy companies. Per capita consumption of raw milk was sourced from national food balance databases, while individual consumption data for dairy products was collected via a 24 h recall survey with 1400 adult respondents. Detectable levels of AFM1 were observed in 7.14% of raw milk samples (up to 0.334 μg/kg) and, albeit at lower amounts (up to 0.009 µg/kg), in 30% and 40% of sour cream and curd cheese, respectively. The AFM1 levels were lower than the national maximum permitted level (0.5 μg/kg); however, levels in raw milk exceeded the EU ML (0.05 μg/kg). The estimated margin of exposure values for dairy products indicated no significant risk, whereas a reasonable worst-case estimate, using the measurable levels of AFM1 in raw milk consumption indicated a potential public health concern. This study provides a scientific basis for evaluating aflatoxin issues in the Caucasus area.

Review of the Terminology, Approaches, and Formulations Used in the Guidelines on Quantitative Risk Assessment of Chemical Hazards in Food

This paper reviews the published terminology, mathematical models, and the possible approaches used to characterise the risk of foodborne chemical hazards, particularly pesticides, metals, mycotoxins, acrylamide, and polycyclic aromatic hydrocarbons (PAHs). The results confirmed the wide variability of the nomenclature used, e.g., 28 different ways of referencing exposure, 13 of cancer risk, or 9 of slope factor. On the other hand, a total of 16 equations were identified to formulate all the risk characterisation parameters of interest. Therefore, the present study proposes a terminology and formulation for some risk characterisation parameters based on the guidelines of international organisations and the literature review. The mathematical model used for non-genotoxic hazards is a ratio in all cases. However, the authors used the probability of cancer or different ratios, such as the margin of exposure (MOE) for genotoxic hazards. For each effect studied per hazard, the non-genotoxic effect was mostly studied in pesticides (79.73%), the genotoxic effect was mostly studied in PAHs (71.15%), and both effects were mainly studied in metals (59.4%). The authors of the works reviewed generally opted for a deterministic approach, although most of those who assessed the risk for mycotoxins or the ratio and risk for acrylamide used the probabilistic approach.

Analyzing consumer perceptions about food safety by applying the food-related lifestyle approach

Food safety standards remain a major concern for consumers, especially in developing and emerging economies, due to gaps in the capacities of food safety enforcement institutions and limited investments from private sector actors. This study analyzes consumer behavior and food safety-related lifestyles in Kosovo, a post-communist emerging economy. Consumer groups were identified according to their food-related lifestyle using the classical 2-stage segmentation approach of factor analysis as well as cluster analysis. The study findings indicate that almost two-thirds of the surveyed consumers are fairly or very concerned about food safety. The results reveal that highly educated female consumers are more concerned about personal health risks, food safety-related content, and related diseases. This study provides interesting insights for food safety policymakers and the agroindustry on how to promote food safety consumer awareness effectively with targeted communication strategies.

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.

Second order probabilistic assessment of chronic dietary exposure to aflatoxin M1 in Serbia

Considering the genotoxic and cancerogenic nature of aflatoxin M1 (AFM1), its presence in milk and dairy products may pose health risks for consumers. The chronic exposure was calculated using a two-dimensional (second order) Monte Carlo model. Results of 13 722 milk and dairy product samples analysed in the 2015-2022 period were used. Milk and dairy products intake information was collected with a Food Frequency Questionnaire (FFQ) validated by a 24-h recall-based method. Risk characterization was done by calculation of the Margin of Exposure (MOE) and by calculation of AFM1 induced number of hepatocellular carcinoma (HCC) cases. Mean AFM1 Estimated Daily Intake (EDI) was highest in children at 0.336 (CI: 0.294-0.385) ng kg^-1 bw day^-1, followed by adolescents with 0.183 (CI: 0.164-0.204), then adult females with 0.161 (CI: 0.146-0.179) and finally adult males with lowest EDI of 0.126 (CI: 0.115-0.139) ng kg^-1 bw day^-1. MOE values based on mean EDI for all population groups were above risk associated threshold and the number of possible HCC cases was in the range of 0.0002-0.0021 cases per year for 10⁵ individuals. The results suggest low health risks due to AFM1 exposure for the whole population. Still, this risk is not non-existent, especially for children as they have a higher ratio of the population exposed to risk associated AFM1 levels, with MOE values below risk indicating threshold starting at 77.5th percentile.

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.

Occurrence of Aflatoxin M1 in Three Types of Milk from Xinjiang, China, and the Risk of Exposure for Milk Consumers in Different Age-Sex Groups

Aflatoxin M1 (AFM1), a group 1 carcinogen, is a risk factor to be monitored in milk. This study aimed to investigate the occurrence of AFM1 in milk in Xinjiang, China, and to assess the risk of exposure for milk consumers in different age-sex groups. A total of 259 milk samples including pasteurized milk (93 samples), extended-shelf-life (ESL) milk (96), and raw donkey milk (70) were collected in Xinjiang from January to March in 2022. The AFM1 content of the milk samples was detected using a validated ELISA method. Of the 259 total samples analyzed for AFM1, 84 (32.4%) samples were contaminated at levels greater than the detection limit of 5 ng/L, with the maximum level of 16.5 ng/L. The positive rates of AFM1 in pasteurized milk and ESL milk were 43.0% (n = 40) and 45.8% (n = 44), respectively, and AFM1 was undetectable in donkey milk. The estimated daily intakes of AFM1 in each age group were lower than the hazard limits and were similar between male and female milk consumers. Therefore, the AFM1 contamination of milk in Xinjiang is low but still needs to be continuously monitored considering that children are susceptible to AFM1.

Probabilistic modeling and risk characterization of the chronic aflatoxin M1 exposure of Hungarian consumers

Aflatoxin contamination can appear in various points of the food chain. If animals are fed with contaminated feed, AFB1 is transformed-among others-to aflatoxin M1 (AFM1) metabolite. AFM1 is less toxic than AFB1, but it is still genotoxic and carcinogenic and it is present in raw and processed milk and all kinds of milk products. In this article, the chronic exposure estimation and risk characterization of Hungarian consumers are presented, based on the AFM1 contamination of milk and dairy products, and calculated with a probabilistic method, the two-dimensional Monte-Carlo model. The calculations were performed using the R plugin (mc2d package) integrated into the KNIME (Konstanz Information Miner) software. The simulations were performed using data from the 2018-2020 food consumption survey. The AFM1 analytical data were derived from the Hungarian monitoring survey and 1,985 milk samples were analyzed within the framework of the joint project of the University of Debrecen and the National Food Chain Safety Office of Hungary (NÉBIH). Limited AFM1 concentrations were available for processed dairy products; therefore, a database of AFM1 processing factors for sour milk products and various cheeses was produced based on the latest literature data, and consumer exposure was calculated with the milk equivalent of the consumed quantities of these products. For risk characterization, the calculation of hazard index (HI), Margin of Exposure, and the hepatocellular carcinoma incidence were used. The results indicate that the group of toddlers that consume a large amount of milk and milk products are exposed to a certain level of health risk. The mean estimated daily intake of toddlers is in the range of 0.008-0.221 ng kg-1 bw day-1; the 97.5th percentile exposure of toddlers is between 0.013 ng kg-1 bw day-1 and 0.379 ng kg-1 bw day-1, resulting in a HI above 1. According to our study, the exposure of older age groups does not pose an emergent health risk. Nevertheless, the presence of carcinogenic compounds should be kept to a minimum in the whole population.

Aflatoxin M1 exposure in a fermented millet-based milk beverage 'brukina' and its cancer risk characterization in Greater Accra, Ghana

Brukina is a millet based fermented milk product which is consumed as a beverage in Ghana. It is however prone to aflatoxin M1 (AFM1) contamination, which is a serious health challenge for low and middle-income countries in subtropical regions. This study aimed at evaluating AFM1 levels and cancer risks associated with brukina (n = 150) sampled from different locations of the Greater Accra Region of Ghana. AFM1 were measured with High-Performance Liquid Chromatography (HPLC) connected to a Fluorescence Detector (FLD).Cancer risk assessments were also conducted using models prescribed by the Joint FAO/WHO Expert Committee on Additives (JECFA). Out of the 150 samples analyzed for AFM1, 80/150 (53%) tested positive between the range 0.00 ± 0.001-3.14 ± 0.77 µg/kg. Cancer risk assessments of AFM1 produced outcomes which ranged between 0.64 and 1.88 ng/kg bw/day, 0.31-9.40, 0.0323, and 1.94 × 10-3-0.06 for cases/100,000 person/yr for Estimated Daily Intake (EDI), Hazard Index (H.I), Average Potency, and Cancer Risks respectively for all age categories investigated. It was concluded that the consumption of brukina posed adverse health effects on the majority of the age categories in the different locations of Greater Accra Region since the calculated H.Is were greater than one (> 1). Therefore, contamination of brukina with AFM1 should be considered a high priority in public health and Ghana's cancer risk management actions.

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.

Seasonal Occurrence of Aflatoxin M1 in Raw Milk during a Five-Year Period in Croatia: Dietary Exposure and Risk Assessment

This study's objective was to estimate the seasonal occurrence of aflatoxin M1 (AFM1) in cow's milk between winter 2016 and winter 2022 and to assess dietary exposure and risk assessment for the adult Croatian population. In total, 5817 cow milk samples were screened for AFM1 concentrations using the enzyme immunoassay assay (ELISA). For confirmation purposes of AFM1 concentration above the European Union maximum permitted level (MRL), ultra high-performance liquid chromatography with tandem mass spectrometry was performed. In 94.7% of milk samples, AFM1 levels were below the detection limit (LOD) of the ELISA test. For 3.47% of samples, the AFM1 was between the LOD and MRL values. Only 1.87% of all samples exceeded the MRL. The mean value of elevated AFM1 in different seasons ranged between 59.2 ng/kg (autumn 2017) and 387.8 ng/kg (autumn 2021). The highest incidences of positive AFM1 were determined in autumn and winter and the maximum (6.4%) was in winter 2019/2020. The largest percentage of positive samples (69.7%) was found in central Croatia. The estimated daily intakes for positive samples ranged between 0.17 and 2.82 ng/kg body weight/day. Risk assessment indicated a high level of concern during autumn and winter, especially for consumers of large amounts of milk.

Aflatoxin M1 in distributed milks in northwestern Iran: occurrence, seasonal variation, and risk assessment

Aflatoxin is one of the dangerous fungal toxins that is produced in the presence of humidity and heat and lack of proper storage conditions and is considered as a dangerous substance threatening human health. The work aimed to determination of aflatoxin M1 (AFM) level in raw, pasteurized, and sterilized milks offered in the study area and to evaluate the risk of its consumption. In this descriptive cross-sectional study, 60 samples of milk types supplied in the region were collected during two series of sampling (cold and hot seasons) and analyzed by ELISA method. LCR, MoE, and HI indices were used to assess the possible risk of consuming milk containing AFM. In all taken samples AFM was found, the toxin concentration range in the first and second series of sampling was 57.5-270.6 ng/L and 57-185.9 ng/L, respectively. The level of toxin in pasteurized and sterilized milks in both sampling series was higher than raw milks. Based on the obtained data and in order to assess the risk of milk consumption in the target population, associated values with EDI, LCR, MoE, and HI were also calculated and obtained in the range of 0.145-0.3 ng/k.d b.w, 0.0008-0.0017 additional case per one million population, 1892.9-3921.6 and 0.72-1.5 ng/kg b.w, respectively. According to the findings, all samples tested are contaminated and although it is within the range of the WHO recommendation, however, based on the calculated indicators, the risk of liver cancer threatens the consumers of these milks. Therefore, it is necessary to manage this issue through educational control and monitoring measures.

A preliminary study on aflatoxin exposure by urine biomonitoring in Chile

We assessed the occurrence of aflatoxin M₁ (AFM₁) in urine in a sample of the MAUCO population-based cohort (n = 120) using an enzyme-linked immune sorbent assay (ELISA) kit specially designed for the analysis of AFM₁ in urine. We found AFM₁ in the urine of 59% of the participants (> limit of detection), with 12% of the samples being over the limit of quantification. The mean of the quantifiable samples was 0.66 (± 0.35) ng/mg adjusted creatinine, ranging from 0.31 to 1.39 ng/mg creatinine. The mean probable daily intake (PDI) of AFB₁ was 0.23 (± 0.37) ng/kg bw according to the upper bound (UB), being significantly higher in women and 0.14 (± 0.23) ng/kg bw in the modified lower bound (mLB) approach, ranging from 0.01 to 1.98 ng/kg bw. The risk of AFB₁ was assessed with the margin of exposure (MOE) approach estimated at 2800 in the mean mLB and 1733 in the mean UB. According to the MOE values obtained in this study, aflatoxin B₁ exposure must be considered a public health concern and must be taken as a priority for food risk management.

Aflatoxin M1 Contamination of Ghanaian Traditional Soft Cottage Cheese (Wagashie) and Health Risks Associated with Its Consumption

Wagashie is an unripened traditional cheese consumed in West Africa including Ghana. Being a milk product, it is unfortunately susceptible to aflatoxin M1 (AFM1) contamination, which is indeed a grave health challenge globally. This study evaluated AFM1 levels and health risk characterization associated with wagashie (n = 182) sampled from different locations in Ghana. AFM1 was measured with high-performance liquid chromatography with a fluorescence detector (HPLC-FLD). Risk assessments were also conducted using models prescribed by the Joint FAO/WHO Expert Committee on Food Additives (JECFA). Out of the 182 samples analyzed for AFM1, 93/182 (51.1%) tested positive between the range 0.00 ± 0.00–3.60 ± 0.99 µg/kg. Risk assessments of AFM1 using deterministic models produced outcomes that ranged between 0.11 and 3.60 ng/kg bw/day, 0.09–1.54, 0–0.0323 ng aflatoxins/kg bw/day, and 3.5 x 10−3 −0.06 cases/100,000 person/yr for estimated daily intake (EDI), margin of exposure (MOE), average potency, and cancer risks, respectively, for the age categories investigated. It was established that the consumption of wagashie posed adverse health effects on all age categories in the selected regions of the study because all calculated MOE values were less than 100,000. Therefore, contamination of wagashie with AFM1 should be a serious public health concern and as such considered a high precedence for Ghana’s risk management actions.

Quantitative risk assessment for aflatoxin M1 associated with the consumption of milk and traditional dairy products in Argentina

A quantitative risk assessment for exposure to aflatoxin M1 (AFM₁) related to the consumption of milk and traditional dairy products of Argentina was developed. The frequency and concentration of AFM₁ was modelled at various stages through the milk processes, considering Argentinean practices. Concentration of AFM₁ (0.046 μg/l, 95%CI = 0.002-0.264 μg/l) in raw milk was estimated. The AFM₁ concentration in milk was sensitive to the carry-over rate (r = 0.80), and milk yield in the first third of lactation during the spring-summer season (r = 0.11). AFB₁ levels in silage (r = 0.22), pasture during the spring-summer season (r = 0.11), concentrate (r = 0.08), and cotton seed (r = 0.05) were the factors most correlated with AFM₁ concentrations. Although the results showed that MoE values for the mean and median exposure to AFM₁ were < 10,000 in infants, toddlers, and other children, the additional cancer risk due to exposure to AFM₁ in infants, toddlers, and other children was 0.007, 0.005, and 0.0009 additional cases per year per 100,000 individuals, respectively, which indicates no health concern. In addition, the percentages of the population exceeding HI values (HI > 1) for exposure to AFM₁ for infants, toddlers, and other children were 45%, 49.1%, and 40.6%, respectively. Under this scenario, the most susceptible population at risk was children < 10 years old; therefore, it is necessary to establish measures to prevent contamination of AFM₁ in milk and milk products.

A Study of the Occurrence of Aflatoxin M1 in Milk Supply Chain over a Seven-Year Period (2014-2020): Human Exposure Assessment and Risk Characterization in the Population of Central Italy

Aflatoxin food contamination represents a rising global issue that will continue to increase due to climate change. Aflatoxin M1 (AFM1) is of high concern for the whole dairy industry. In light of AFM1's harmful potential, a human health exposure assessment and risk characterization were performed for all age populations of central Italy with regard to milk and cheese consumption by means of the margin of exposure (MOE). In total, 16,934 cow and ewe's milk samples were collected from 2014 to 2020 and analyzed by an enzyme-linked immunosorbent assay (ELISA) screening method, confirmed by high-performance liquid chromatography with a fluorescence detector (HPLC-FLD). The average concentration of AFM1 in cow's milk ranged from 0.009 to 0.015 µg/kg, while in ewe's milk, the average concentration ranged from 0.009 to 0.013 µg/kg. The average amount of AFM1 exposure ranged from 0.00005 to 0.00195 g/kg bw/day, with the main contributor represented by drinking milk, followed by the consumption of soft cheeses. A high level of public health concern related to the youngest consumers has arisen from risk characterizations highlighting the need for constant monitoring of AFM1's occurrence in milk by inspection authorities, alongside regular updates with regard to exposure assessments.

Consumer Perception of Food Quality and Safety in Western Balkan Countries: Evidence from Albania and Kosovo

Domestic food markets are of significant importance to Kosovar and Albanian companies because access to export markets is under-developed, partly as a result of the gaps in food safety and quality standards. Kosovar and Albanian consumers’ use of food safety attributes and their evaluation of the quality of domestic food versus imported food are the research objectives of this study. The paper is based on a structured consumer survey of 300 Kosovars and 349 Albanians analyzing their perceptions of issues related to food safety and quality, measured through two respective batteries of items using a 5-point Likert scale. We used the t-test to identify differences between populations, correlation analysis and the bootstrapping method. Despite the prevalent problems with food safety, consumers in both countries consider domestic food to be safer as well as of higher quality than imported products. Kosovars are more likely than Albanians to perceive domestic food products to be significantly better than imported products. Female and better educated consumers use information related to food safety more often. Expiry date, domestic and local origin, and brand reputation are the most frequently used safety and quality cues for both samples. International food standards such as ISO or HACCP are less frequently used as quality cues by these consumer groups. It is important to strengthen the institutional framework related to food safety and quality following best practices from EU countries.

Dairy Consumption and Liver Cancer Risk: A Systematic Review and Dose-Response Meta-Analysis of Observational Studies

The relationship of dairy consumption and liver cancer risk is still controversial. We conducted a meta-analysis of published cohort and case-control studies to summarize the epidemiologic evidence on the relationship between dairy products consumption and the risk of liver cancer. The literatures were screened from PubMed, EMBASE, and Cochrane Library before May 2020. A total of seven cohort studies and eight case-control studies (5,121 cases) were included. The summary relative risks (RRs) were 1.17 (95% CI: 0.87‒1.57) and 1.08 (95% CI: 0.78‒1.51) for milk and total dairy, respectively. 0.50 (95% CI: 0.27-0.91) and 1.16 (95% CI: 0.83-1.52) were yogurt, cheese, and curd. Subgroup analysis revealed that study duration, alcohol, and design were associated the RRs. Dose-response analysis showed that the liver cancer risk was decreased by 5.4% (P for linear trend = 0.002) with a 40 g/day increment of yogurt intake. These results suggested that total dairy, milk, cheese, and curd were positive associations with the liver cancer risk although they were not statistically significant, however higher yogurt intake would reduce the risk. Further studies are necessary to verify the relationship of dairy foods with cancer.

Aflatoxin M1 in raw cow milk and associated hepatocellular carcinoma risk among dairy farming households in Malawi

In the present study, a total of 112 raw milk samples were collected between October and December of 2018 from dairy farming households in Malawi and analyzed for aflatoxin M1 (AFM1) using VICAM aflatest fluorometry procedure. These data together with the consumption data obtained through a milk consumption frequency questionnaire were used for the calculation of AFM₁ exposure and its association with hepatocarcinoma (HCC) risk in dairy farming population. Average daily milk intake by children and adults were approximately 300 ± 0.07 and 541.7 ± 0.14 mL, respectively. All raw milk samples tested positive to AFM₁ averaging 0.551 μg/L. Probable mean daily exposure to AFM₁ for adults was 4.98 ± 7.25 ng/kg BW/day almost half that of children (8.28 ± 11.82 ng/kg BW/day). Estimated risk of AFM₁-induced HCC associated with consumption of milk among children and adults were 0.038 and 0.023 cases per 100,000 individuals per year, respectively. Although the results of this investigation suggest a low risk of HCC, other negative health effects of AFM₁ justify its continuous monitoring and update of the risk assessment. This work presents the first insight in the occurrence of AFM₁ in cow milk in Malawi as well as associated AFM₁ exposure in dairy farming population.

Aflatoxins in Milk and Dairy Products: Occurrence and Exposure Assessment for the Serbian Population

The main objective of this study was to assess the exposure associated with aflatoxin M1 (AFM1) of the adult population in Serbia from consumption of milk and dairy products. This assessment was performed using concentration values of AFM1 in raw milk (385 samples) and dairy products (556 samples) based on the analyses conducted in the period between 2015 and 2018. In parallel, a dairy products consumption survey was completed during 2018 based on ‘one-day’ and ‘seven-day’ recall methods. In order to estimate the intake of AFM1 from the consumption of dairy products for both recall methods, a Monte Carlo simulation was conducted. The study revealed that pasteurized milk and yogurt are dairy products mostly consumed by the Serbian adult population. Estimated daily intake of AFM1 was in the range of 62–74 × 10−3 ng/kg bw/day, depending on the recall methods and scenarios employed. Although the results show moderate exposure risks compared to similar studies worldwide, climatic conditions and weather extremes that have occurred recently may have negatively influenced the contamination of feed and, consequently, AFM1 contamination of milk. As a result, it is justifiable to promote continuous monitoring in feed and dairy supply chains in Serbia and provide an update of exposure assessment.

Health risk assessment of aflatoxin M1 in infant formula milk in IR Iran

In this study, two accurate, precise, selective and sensitive methods were developed for determining aflatoxin M1 (AFM1) in infant formula milk using immunoaffinity column clean-up followed by high performance liquid chromatography (HPLC) with fluorescence detection. The validated methods were used for determination of AFM1 in 29 samples of 6 different infant formula milk brands and the risk of AFM1 in infants aged zero to 6 months old was assessed using cancer risk, Margin of Exposure (MOE) and Hazard Index (HI). Only one sample (3.4%) was contaminated with AFM1. Although the results showed that MOE values for the mean and median exposure to AFM1 was <10,000 in infants, the additional cancer risk due to mean and median exposure to AFM1 in infant <6 months were 0.00010 and 0.00012 additional cases per year per 10⁵ individuals, respectively, which indicates no health concern. In addition, HI values for the mean and median exposure to AFM1 for infants were quite below one which indicates no health concern. To the best of our knowledge, this is the first report on risk assessment of AFM1 in infant formula milk consumed by Iranian infants <6 months old, presenting a low risk for the evaluated groups.

The Occurrence and Dietary Exposure Assessment of Mycotoxins, Biogenic Amines, and Heavy Metals in Mould-Ripened Blue Cheeses

The occurrence and dietary exposure assessment of 16 mycotoxins, 6 biogenic amines (BAs), and 13 metallic elements in blue-veined cheeses (n = 46) is reported. Co-occurrence of mycophenolic acid (≤599 µg·kg-1) with roquefortine C (≤5454 µg·kg-1) was observed in 63% of the tested cheeses, while BAs were frequently present at concentrations between 0.2 and 717 mg kg-1. The concentrations of heavy metals in cheeses were very low. Chronic/acute exposure assessment based on consumption data from different European populations indicated that the levels of mycotoxins and heavy metals are safe to consumers, whereas, rather high hazard indexes (HI up to 0.77) were determined for BAs according to the worst-case scenario based on high consumption and 95th percentile occurrence. A more detailed acute dietary intake study indicated that histamine and tyramine were predominant among these BAs, reaching 27 and 41% of the acute oral intake reference doses.

Main environmental impacts associated with production and consumption of milk and yogurt in Serbia - Monte Carlo approach

Dairy consumption studies or life cycle assessment of dairy products have been in research focus for several years providing useful information. However, limited number of studies confronted the two types of data in order to analyze environmental impacts associated with consumers. The objective of this research was to calculate these impacts, namely global warming potential (GWP), ozone depletion potential (ODP), cumulative energy demand (CED), acidification potential (AP) and eutrophication potential (EP) related to the consumption of milk and yogurt in Serbia. In the present paper, life cycle assessment study was performed using data from nine dairy farms and ten dairy plants. The system boundary applied is 'cradle-to-retail' comprising data from cow farms, raw milk transportation, processing and transportation of dairy products. In parallel, a survey on the consumption of milk and yogurt was conducted analyzing responses from 957 dairy product consumers. It was found that milk production is responsible for the emission of 1.511 kg CO2_e/kg of milk, 7.720 MJ_e/kg, 0.1363 mg R11_e/kg, 12.164 g SO_2e/kg and 17.825 g PO_4e/kg while the results for yogurt are slightly higher 1.672 kg CO2_e/kg, 7.804 7.720 MJ_e/kg, 0.1369 mg R11_e/kg, 12.238 g SO_2e/kg and 17.609 g PO_4e/kg. Further calculations also revealed that weekly emission of GWP, CED, ODP, AP and EP associated with an average consumer of milk and/or yogurt in Serbia was estimated at values of 2.254 kg CO_2e/week, 10.926 MJ_e/week, 0.19261 mg R11_e/week, 17.191 g SO_2e/week and 24.363 g PO_4e/week. These results may be of interest to all actors in the dairy chain giving them a wider perspective of sustainable consumption of dairy products.

Occurrence of Aflatoxin M1 in Raw Milk Marketed in Italy: Exposure Assessment and Risk Characterization

The current study is based on the AFM1 contamination of milk determined from April 2013 to December 2018 in the framework of a self-control plan of six milk processing plants in Italy. These data - together with the consumption data of milk consumers - were evaluated and used for the calculation of the Estimated Daily Intake (EDI), the Hazard Index (HI), and the fraction of hepatocarcinoma cases (HCC) due to AFM1 exposure in different population groups. Altogether a total of 31,702 milk samples were analyzed, representing 556,413 tons of milk, which is an outstanding amount compared to published studies. The results indicate the monthly fluctuation of AFM1 levels through a period of nearly 6 years. The EDI of AFM1 in different population groups was in the range of 0.025-0.328 ng kg-1 body weight (bw) per day, based on the average consumption levels and weighted mean contamination of the milk in the study period. Considering average consumptions, in the groups of infants and toddlers, the HI calculation resulted in 1.64 and 1.4, respectively, while for older age groups, it was <1. The estimated fractions of HCC incidences attributable to the AFM1 intakes were 0.005 and 0.004 cases per 100,000 individuals in the 0-0.9 and 1-2.9-year age groups, respectively, and below 0.004 cases in the other age categories. The monthly average AFM1 contamination of tested milk consignments ranged between 7.19 and 22.53 ng kg-1. Although the results of this extensive investigation showed a low risk of HCC, the variability of climatic conditions throughout years that influence AFB1 contamination of feed and consequently AFM1 contamination of milk justifies their continuous monitoring and update of the risk assessment.