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Monge A, Romero M, Groopman JD, McGlynn KA, Santiago-Ruiz L, Villalpando-Hernández S, Mannan R, Burke SM, Remes-Troche JM, Lajous M. Aflatoxin exposure in adults in southern and eastern Mexico in 2018: A descriptive study. Int J Hyg Environ Health 2023; 253:114249. [PMID: 37672956 PMCID: PMC10538954 DOI: 10.1016/j.ijheh.2023.114249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/08/2023] [Accepted: 08/24/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To estimate the frequency of detection and levels of aflatoxin B1-lysine adduct (AFB1-lys), an important hepatocellular carcinoma (HCC) risk factor, in eastern and southern Mexico. MATERIALS AND METHODS We determined serum AFB1-lys using mass spectrometry in a representative sample of 952 adults (weighted n = 7,493,354) from five states (Campeche, Chiapas, Tamaulipas, Veracruz and Yucatán) in 2018. We calculated overall and subgroup-specific frequency of detection and 95% confidence intervals (95%CI) and median AFB1-lys levels and quartiles. RESULTS The overall frequency of detection of AFB1-lys was 91.9% (95%CI 88.6, 94.3). The median AFB1-lys level was 0.172 pg/μL (Q1-Q3, 0.060-0.582). Levels differed geographically (median pg/μL, 0.361 for Veracruz and 0.061 for Yucatan) and were higher among men and older individuals. Levels were almost three times higher in rural relative to urban areas (0.317 vs. 0.123 pg/μL). We observed higher AFB1-lys exposure in lower socioeconomic status (SES) level populations. CONCLUSION AFB1-lys frequency of detection was very high and exposure levels were highest in Veracruz, men, rural areas, and among persons of lower SES. Understanding modifiable HCC risk factors in populations with unique epidemiological patterns could inform preventative interventions.
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Affiliation(s)
- Adriana Monge
- Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Martín Romero
- Center for Research on Evaluation and Surveys, National Institute of Public Health, Cuernavaca, Mexico
| | - John D Groopman
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Luis Santiago-Ruiz
- Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Reima Mannan
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sean M Burke
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Martín Lajous
- Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Mexico; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA.
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Matchado A, Smith JW, Schulze KJ, Groopman JD, Kortekangas E, Chaima D, Arnold CD, Maleta K, Ashorn U, Ashorn P, Dewey KG, Stewart CP. Child Aflatoxin Exposure is Associated with Poor Child Growth Outcomes: A Prospective Cohort Study in Rural Malawi. Curr Dev Nutr 2023; 7:101962. [PMID: 37426291 PMCID: PMC10328803 DOI: 10.1016/j.cdnut.2023.101962] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/19/2023] [Accepted: 06/07/2023] [Indexed: 07/11/2023] Open
Abstract
Background Aflatoxin (AF) exposure is associated with child growth faltering in cross-sectional studies, with limited findings from longitudinal studies. Objectives To evaluate the relationship between maternal AF B1-lysine adduct concentration, child AF B1-lysine adduct concentration, and child growth in the first 30 mo of life. Methods AF B1-lysine adduct was measured in mother-child dyad plasma samples using isotope dilution mass spectrometry. Using linear regression, we assessed the relationship between AF B1-lysine adduct concentration and child weight, height, and head and mid-upper arm circumferences at 1 wk, 6, 12, 18, 24, and 30 mo of age. Results In adjusted models, maternal prenatal AF B1-lysine adduct (pg/μL) was positively associated with newborn anthropometric outcomes; largest beta coefficients for associations between standardized values were for newborn weight-for-age z-score [β = 0.13; 95% confidence interval (CI): 0.02, 0.24; P < 0.05 and β = 0.11; 95% CI: 0.00, 0.22; P < 0.05 for second and third trimester AF, respectively]. Child AF B1-lysine adduct (pg/μL) at 6 mo was negatively associated with head circumference-for-age z-score at 6, 18, 24, and 30 mo, with beta coefficients ranging from β = -0.15; 95% CI: -0.28, -0.02 to β = -0.17; 95% CI: -0.31, -0.03; P < 0.05); 18-mo AF was negatively associated with anthropometric outcomes at 18, 24, and 30 mo, most consistently with length-for-age z-score (β = -0.18; 95% CI: -0.32, -0.04, β = -0.21; 95% CI: -0.35, -0.07, β = -0.18; 95% CI: -0.32, -0.03 at 18, 24 and 30 mo, respectively). Conclusions Child AF exposure was associated with impaired child growth, but maternal AF exposure was not. Exposure during infancy was linked to persistent deficit in head circumference, implying reduced brain size lasting beyond the age of 2 years. Exposure at 18 mo was linked to persistent linear growth deficit. Further research should elucidate mechanisms through which AF affects child growth.
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Affiliation(s)
- Andrew Matchado
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA, United States
| | - Joshua W. Smith
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Kerry J. Schulze
- Department of International Health, Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - John D. Groopman
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Emma Kortekangas
- Center for Child, Adolescent, and Maternal Health Research, Tampere University and Tampere University Hospital, Tampere, Finland
| | - David Chaima
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Charles D. Arnold
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA, United States
| | - Kenneth Maleta
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Ulla Ashorn
- Center for Child, Adolescent, and Maternal Health Research, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Per Ashorn
- Center for Child, Adolescent, and Maternal Health Research, Tampere University and Tampere University Hospital, Tampere, Finland
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Kathryn G. Dewey
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA, United States
| | - Christine P. Stewart
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA, United States
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Renaud JB, Walsh JP, Sumarah MW. Optimization of Aflatoxin B1-Lysine Analysis for Public Health Exposure Studies. Toxins (Basel) 2022; 14:toxins14100672. [PMID: 36287941 PMCID: PMC9606987 DOI: 10.3390/toxins14100672] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/30/2022] Open
Abstract
Aflatoxin B1 is a potent human carcinogen produced by several species of Aspergillus mainly found on nuts and maize. Exposures in parts of Africa, Latin America and Asia can be at multiples, sometimes orders of magnitude above tolerable daily levels. Although human exposure to aflatoxin can be estimated by analysis of the diet, only determination of the serum albumin aflatoxin adduct provides a health-relevant exposure measure. The lack of a reference serum limits interlaboratory method validation and data comparisons. In this study, we synthetically produced AFB1-dialdehyde and covalently coupled it to serum albumin in human serum. This synthetic produced aflatoxin-serum reference material was used in conjunction with isotopically labelled internal standards to evaluate sample digestion methods. This showed using sufficient Pronase in the digestion step was critical to ensure complete proteolytic digestion, which occurs within 4 h. Increasing the digestion temperature from 37 °C to 50 °C also provided a benefit to the overall analysis. In addition, the use of dried blood spots and Volumetric Absorptive Microsampling (VAMS) were investigated showing samples stored with VAMS produced equivalent results to serum samples.
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Affiliation(s)
- Justin B Renaud
- London Research and Development Centre, Agriculture and Agri-Food Canada, London, ON N5V 4T3, Canada
- Correspondence: (J.B.R.); (M.W.S.)
| | - Jacob P Walsh
- London Research and Development Centre, Agriculture and Agri-Food Canada, London, ON N5V 4T3, Canada
- Department of Chemistry, University of Western Ontario, London, ON N6A 3K7, Canada
| | - Mark W Sumarah
- London Research and Development Centre, Agriculture and Agri-Food Canada, London, ON N5V 4T3, Canada
- Department of Chemistry, University of Western Ontario, London, ON N6A 3K7, Canada
- Correspondence: (J.B.R.); (M.W.S.)
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Assessing the Impacts of Preanalytical Field Sampling Challenges on the Reliability of Serum Aflatoxin B1-Lysine Measurements by Use of LC-MS/MS. Toxins (Basel) 2022; 14:toxins14090612. [PMID: 36136549 PMCID: PMC9503385 DOI: 10.3390/toxins14090612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/15/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
Aflatoxin exposure is endemic in developing countries with warm, humid climates that promote toxigenic mold growth on crops and foodstuffs. Estimating human aflatoxin exposure is key to identifying and abating contamination sources. Serum aflatoxin B1 bound to albumin lysine (AFB1-lys) is a preferred exposure biomarker, but field sample collection, processing, transportation, and storage logistics are challenging. We validated an improved LC-MS/MS method for serum AFB1-lys and applied it to three field sampling challenges: transportation/storage (elevated temperature); collection/processing (hemolysis); and sample type substitution (heparinized plasma). Our new LC-MS/MS method had a LOD of 0.03 ng/mL, accuracy (mean spike recovery) of 112%, total imprecision (replicate pool measurements) ≤5% at ≥0.2 ng/mL, and results that were 95.1% similar (mean percentage similarity) to an established method. AFB1-lys in human serum spiked with serum from aflatoxin-dosed rats was stable for 14 days at both ambient (22.5 °C) and elevated (38 °C) temperatures. Simulated hemolysis (adding 0.25–3 mg hemoglobin) did not affect AFB1-lys accuracy at ≥0.5 ng/mL but caused 10–25% signal suppression. Heparinized plasma AFB1-lys was 99.0% similar to serum but interfered with albumin measurements (bromocresol green) causing spurious low bias. Further investigation is warranted, but our findings suggest that AFB1-lys is pre-analytically robust.
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