Aflatoxin B₁exposure and liver cirrhosis in Guatemala: a case–control study

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p>In Guatemala, cirrhosis is among the 10 leading causes of death, and mortality rates have increased lately. The reasons for this heavy burden of disease are not clear as the prevalence of prominent risk factors, such as hepatitis B virus, hepatitis C virus and heavy alcohol consumption, appears to be low. Aflatoxin B<jats:sub>1</jats:sub> (AFB<jats:sub>1</jats:sub>) exposure, however, appears to be high, and thus could be associated with the high burden of cirrhosis. Whether AFB<jats:sub>1</jats:sub> increases the risk of cirrhosis in the absence of viral infection, however, is not clear.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Cirrhosis cases (n=100) from two major referral hospitals in Guatemala City were compared with controls (n=200) from a cross-sectional study. Logistic regression was used to estimate the ORs and 95% CIs of cirrhosis and quintiles of AFB<jats:sub>1</jats:sub> in crude and adjusted models. A sex-stratified analysis was also conducted.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The median AFB<jats:sub>1</jats:sub> level was significantly higher among the cases (11.4 pg/mg) than controls (5.11 pg/mg). In logistic regression analyses, higher levels of AFB<jats:sub>1</jats:sub> was associated with cirrhosis (quintile 5 vs quintile 1, OR: 11.55; 95% CI 4.05 to 32.89). No attenuation was observed with adjustment by sex, ethnicity, hepatitis B virus status, and heavy alcohol consumption. A significantly increasing trend in association was observed in both models (p trend &lt;0.01). Additionally, the cirrhosis–AFB<jats:sub>1</jats:sub> association was more prominent among men.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The current study found a significant positive association between AFB<jats:sub>1</jats:sub> exposure and cirrhosis. Mitigation of AFB<jats:sub>1</jats:sub> exposure and a better understanding of additional risk factors may be important to reduce the burden of cirrhosis in Guatemala.</jats:p></jats:sec>

Associations between Serum Aflatoxin-B1 and Anemia in Pregnant Women: Evidence from Guangxi Zhuang Birth Cohort in China

“…Furthermore, we observed a sex-specific effect that mothers with male infants were more likely to be affected by aflatoxin. This is congruent with previous reports finding that the metabolism of aflatoxin was different between sexes, and males were more susceptible to aflatoxin [32,33]. However, the underlying mechanisms for this difference is still unclear.…”

Worldwide aflatoxin contamination of agricultural products and foods: From occurrence to control

“…Aflatoxin B1, due to its toxic, mutagenic, immunotoxic, teratogenic, and carcinogenic effect on humans and animals, is classified as a group 1 carcinogen in the International Agency for Research on Cancer (IARC) classification of carcinogenic substances (Ostry et al., 2017). As potent carcinogen, aflatoxin B1 may affect organs like the liver and kidneys (Alvarez et al., 2020; Li et al., 2018). It is also reported to suppress humans’ immune systems, rendering them vulnerable to infectious diseases like HIV and AIDS (Jiang et al., 2008; Jolly et al., 2013).…”

Assessment of aflatoxin exposure, growth faltering and the gut microbiome among children in rural Guatemala: protocol for an observational prospective cohort and bioreactor simulations

“…The rural Indigenous population in Guatemala has one of the highest rates of child stunting in the world. Interest in a possible role for aflatoxin in stunting has grown in recent years, made more compelling by the observation that many countries with high rates of stunting consume large amounts of maize and have documented aflatoxin in food sources 2–7. However, most studies have been cross-sectional and have not assessed seasonal variations in aflatoxin, food preparation and dynamic changes in child growth.…”