Aflatoxin Exposure and Viral Hepatitis in the Etiology of Liver Cirrhosis in The Gambia, West Africa

Abstract

BackgroundCirrhosis of the liver is thought to be a major cause of morbidity and mortality in sub-Saharan Africa, but few controlled studies on the etiology of cirrhosis have been conducted in this region.ObjectivesWe aimed to elucidate the association between environmental and infectious exposures and cirrhosis in The Gambia.MethodsNinety-seven individuals were diagnosed with cirrhosis using a validated ultrasound scoring system and were compared with 397 controls. Participants reported demographic and food frequency information. Blood samples were tested for hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), hepatitis C virus (HCV) antibody, HCV RNA, and the aflatoxin-associated 249ser TP53 mutation.ResultsHBsAg seropositivity was associated with a significant increase in risk of cirrhosis [odds ratio (OR) = 8.0; 95% confidence interval (CI), 4.4–14.7] as was the presence of HBeAg (OR = 10.3; 95% CI, 2.0–53.9) and HCV infection (OR = 3.3; 95% CI, 1.2–9.5). We present novel data that exposure to aflatoxin, as assessed both by high lifetime groundnut (peanut) intake and by the presence of the 249ser TP53 mutation in plasma, is associated with a significant increase in the risk for cirrhosis (OR = 2.8; 95% CI, 1.1–7.7 and OR = 3.8; 95% CI, 1.5–9.6, respectively). Additionally, aflatoxin and hepatitis B virus exposure appeared to interact synergistically to substantially increase the risk of cirrhosis, although this was not statistically significant.ConclusionsOur results suggest that the spectrum of morbidity associated with aflatoxin exposure could include cirrhosis.

International agricultural research to reduce food risks: case studies on aflatoxins

“…Other studies show associations between aflatoxins and stillbirths (Lamplugh et al 1988;Vries et al 1989), liver cirrhosis (Kuniholm et al 2008), jaundice in newborns (Abdulrazzaq et al 2004;Abulu et al 1998;Ahmed et al 1995;Sodeinde et al 1995) and immunosuppression (Jiang et al 2005;Turner et al 2003).…”

Clinical Outcomes and Correlates of TP53 Mutations and Cancer

“…In areas of West Africa with lower aflatoxin exposure, 249ser mutation can still be detected in plasma in HCC patients, and is under development as an early diagnostic marker in the first intervention study of its kind (Szymanska et al 2004). Lately, the presence of 249ser mutation as a biomarker of exposure to aflatoxin has uncovered a link between aflatoxin exposure and cirrhosis (Kuniholm et al 2008). …”

Aflatoxin Contamination in Foods and Feeds: A Special Focus on Africa

“…In some cases of cirrhosis, there is an over expression of the p53 gene and this has been related to simple cellular stress or mutation of the gene, which occurs in many of the subjects exposed to HBV and/or AFB 1 (Livni et al, 1995). More recent work on cirrhosis in The Gambia (Kuniholm et al 2008) tentatively concludes that health effects due to exposure to AFB 1 could include this disease. It would seem that, because of various factors that African populations face, including alcohol abuse, it is difficult to tease out any particular one and ascribe a role to it, other than it does make a contribution to the overall condition.…”