Exposure to multiple mycotoxins, environmental enteric dysfunction and child growth: Results from the AflaCohort Study in Banke, Nepal

Abstract

Evidence of the impact of exposure to multiple mycotoxins and environment enteric dysfunction (EED) on child growth is limited. Using data from a birth cohort study, the objectives of this study were to (a) quantify exposure to multiple mycotoxins (serum aflatoxin [AFB 1 ] and ochratoxin A [OTA], urinary fumonisin [UFB 1 ] and deoxynivalenol [DON]), as well EED (lactulose:mannitol [L:M] ratio); (b) examine the potential combined effects of multiple mycotoxin exposure and EED on growth.Multivariate regressions were used to identify associations between growth measurements (length, weight, anthropometric z-scores, stunting and underweight) at 24-26 months of age and exposure to mycotoxins and EED at 18-22 months (n = 699). Prevalence of AFB 1 , DON, OTA and UFB 1 exposure ranged from 85% to 100%; average L:M ratio was 0.29 ± 0.53. In individual mycotoxin models, AFB 1 exposure was negatively associated with weight, WAZ, increased odds of stunting (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 1.08, 1.52; p = 0.004) and underweight (OR: 1.18, 95% CI: 1.00, 1.38; p = 0.046). Irrespective of other mycotoxin exposure and presence of EED, AFB 1 was negatively associated with length, weight, head circumference, LAZ and WAZ, and with increased odds of stunting and underweight, UFB 1 was associated with increased odds of underweight, and DON was negatively associated with head circumference. EED was associated with the impaired length and weight. These findings suggest that certain mycotoxins and EED may have independent impacts on different facets of growth and that aflatoxin dominates such impacts. Thus, programs reducing exposure to mycotoxin and EED through multi-sectoral nutrition-sensitive interventions have the potential to improve child growth.

A systematic review with meta-analysis of the relation of aflatoxin B1 to growth impairment in infants/children

“…Studies were from 2 continents, 11 from Africa and 4 from Asia. Of these, 8 records were prospective cohort [ 14 , 15 , 21 , 36 , 38 – 40 , 42 ] and 7 records were non-cohort [ 16 , 17 , 33 – 35 , 37 , 41 ] in design. The sample size of the included studies ranged between 46 and 1484 participants.…”

Aflatoxin Contamination, Exposure among Rural Smallholder Farming Tanzanian Mothers and Associations with Growth among Their Children

“…Understanding the biology underlying the relation between aflatoxin and growth is also crucial to investigate. This is because it is hypothesized that aflatoxins can alter mucosal barriers and affect resistance to intestinal infections [26] and micronutrient absorption [26,27] leading to growth impairment. Besides this, investigating the presence of multiple mycotoxins is imperative as mycotoxins are common in grains as mixtures, particularly with fumonisins in maize [28].…”

Prenatal ochratoxin A exposure, birth outcomes and infant growth in rural Burkina Faso: a human biomonitoring sub-study from the MISAME-III trial

“…Mycotoxins are secondary metabolites from fungi that grow on crops preharvest, as well as in postharvest, storage and/or in food processing (Andrews-Trevino et al, 2022;De Boevre et al, 2012;Marin et al, 2013;Pitt et al, 2000). Mycotoxin contamination commonly affects popular food items in West Africa, including chilies, maize, peanuts, and spices (Abiala et al, 2011;Ngum et al, 2022).…”