Aflatoxin is a food contaminant and its exposure through the diet is frequent and ubiquitous. A long-term dietary aflatoxin exposure has been linked to the development of liver cancer in populations with high prevalence of aflatoxin contamination in foods. Therefore, this study was conducted to identify the association between urinary aflatoxin M1 (AFM1), a biomarker of aflatoxin exposure, with the dietary intake among adults in Hulu Langat district, Selangor, Malaysia. Certain food products have higher potential for aflatoxin contamination and these were listed in a Food Frequency Questionnaire, which was given to all study participants. This allowed us to record consumption rates for each food product listed. Concomitantly, urine samples were collected, from adults in selected areas in Hulu Langat district, for the measurement of AFM1 levels using an ELISA kit. Of the 444 urine samples collected and tested, 199 were positive for AFM1, with 37 of them exceeding the limit of detection (LOD) of 0.64 ng/mL. Cereal products showed the highest consumption level among all food groups, with an average intake of 512.54 g per day. Chi-square analysis showed that consumption of eggs (X2 = 4.77, p = 0.03) and dairy products (X2 = 19.36, p < 0.01) had significant associations with urinary AFM1 but both food groups were having a phi and Cramer’s V value that less than 0.3, which indicated that the association between these food groups’ consumption and AFM1 level in urine was weak.

Background: Aflatoxin occurrence could be affected by several factors. This study aimed to assess the association between knowledge, attitude and practice (KAP) towards aflatoxin and sociodemographic factors with urinary AFM1 occurrence among residents in Hulu Langat, Selangor. Methods: A cross-sectional study was conducted among healthy Malaysian adults aged 18 to 60 years in six subdistricts of Hulu Langat, Selangor. Sociodemographic factors and KAP towards aflatoxin were assessed via questionnaires while morning urine sample was collected for AFM 1 analysis. Of 444 respondents, the urinary AFM 1 level was detected in 199 samples (detection rate = 44.8 %). From 37 positive samples with AFM 1 level above the detection limit of 0.64 ng/ml, the mean value was 1.23 ± 0.91 ng/ml with a range of 0.65 – 5.34 ng/ml (median = 0.89 ng/ml). The variables were examined based on the occurrence of urinary AFM 1 biomarker. Results: Findings showed that there were significant differences in urinary AFM1 occurrence across ethnicity ( p <0.01), age group ( p <0.05), monthly household income ( p <0.01), as well as attitude ( p <0.01) and practice ( p <0.05) towards aflatoxin contamination in food. Binomial logistic regression confirmed that ethnicity and monthly household income were the factors contributing to urinary aflatoxin occurrence ( p <0.01). Chinese were 3.20 times more likely to have aflatoxin exposure than the non-Chinese. Detected urinary AFM 1 was more common among household with income more than RM 1500 monthly. Conclusion: The results provided an insight to explain the variation in aflatoxin occurrence among the population. Trial registration: Ethics Committee for Research Involving Human Subjects Universiti Putra Malaysia (JKEUPM), project number: FPSK (EXP16) P047

Introduction: Chronic exposure to aflatoxin can lead to complications such as liver failure and cancer. There are many factors that affect aflatoxin occurrence. This study aimed to assess the association between sociodemographic factors and the knowledge, attitude and practice towards aflatoxin with urinary aflatoxin M1 occurrence among residents in Hulu Langat district, Malaysia. Methods: This was a cross-sectional study conducted among healthy Malaysian adults aged 18 to 60 years residing in Hulu Langat district, Malaysia. Socio-demographic background and the knowledge, attitude and practice of respondents towards aflatoxin were assessed through questionnaires. Non-fasting urine sample (15 ml) was collected in the morning and urinary aflatoxin M1 level was quantified. Results: Of the 444 healthy Malaysian adults, 199 urine samples were detected with aflatoxin M1. From 37 positive samples with aflatoxin M1 level above detection limit (0.64 ng/ml), mean value was 1.23±0.91 ng/ml (range = 0.65-5.34 ng/ml). Urinary aflatoxin M1 occurrence was significantly different across ethnicity, age group, monthly household income, attitude and practice towards aflatoxin. Binomial logistic regression confirmed ethnicity and monthly household income as factors contributing to urinary aflatoxin M1 occurrence. Chinese were 3.20 times more likely to have aflatoxin exposure than non-Chinese. Detected urinary aflatoxin M1 was more common among household with a monthly income above RM1,500. Conclusion: The results provided an insight to explain the variation in aflatoxin occurrence among the population.