An improved "dilute and shoot" LC-MS/MS multibiomarker approach was used to monitor urinary excretion of 23 mycotoxins and their metabolites in human populations from Asia (Bangladesh), Europe (Germany), and the Caribbean region (Haiti). Deoxynivalenol (DON), deoxynivalenol-3-glucuronide (DON-3-GlcA), T-2-toxin (T-2), HT-2-toxin (HT-2), HT-2-toxin-4-glucuronide (HT-2-4-GlcA), fumonisin B1 (FB1), aflatoxins (AFB1, AFB2, AFG1, AFG2, AFM1), zearalenone (ZEA), zearalanone (ZAN), their urinary metabolites α-zearalanol (α-ZEL) and β-zearalanol (β-ZEL), and corresponding 14-O-glucuronic acid conjugates (ZEA-14-GlcA, ZAN-14-GlcA, β-ZEL, α/β-ZEL-14-GlcA), ochratoxin A (OTA), and ochratoxin alpha (OTα) as well as enniatin B (EnB) and dihydrocitrinone (DH-CIT) were among these compounds. Eight urinary mycotoxin biomarkers were detected (AFM1, DH-CIT, DON, DON-GLcA, EnB, FB1, OTA, and α-ZEL). DON and DON-GlcA were exclusively detected in urines from Germany and Haiti whereas urinary OTA and DH-CIT concentrations were significantly higher in Bangladeshi samples. AFM1 was present in samples from Bangladesh and Haiti only. Exposure was estimated by the calculation of probable daily intakes (PDI), and estimates suggested occasional instances of toxin intakes that exceed established tolerable daily intakes (TDI). The detection of individual mycotoxin exposure by biomarker-based approaches is a meaningful addition to the classical monitoring of the mycotoxin content of the food supply.