Assessment of aflatoxin M₁ exposure and associated determinants in children from Lahore, Pakistan

Abstract

Aflatoxins are potent carcinogenic and immunomodulatory mycotoxins, and exposure may lead to deleterious effects on human health. This study aimed to detect aflatoxin M₁ (AFM₁) as biomarker of exposure and determine associated risk factors in children attending a specialized-childcare hospital in Lahore. Urine samples collected from 238 children (1–11 years) during winter (January–mid-March 2020) and hot-humid summer (August–September 2020) were tested for AFM₁ presence using ELISA. Data on potential risk factors were also collected. Of 238 samples, 156 (65.5%) were positive for urinary AFM₁. Season was significantly associated (OR = 2.64; 95% CI = 1.49–4.79; p = 0.001) with AFM₁ positivity; prevalence was higher in hot-humid months (74.6%) than winter (57.3%). The place of living was also significantly associated (OR = 2.21; 95% CI = 1.25–3.97; p = 0.007), and urinary AFM₁ positivity was higher in urban children (71.1%) compared to rural (58.3%). Median value for creatinine-adjusted AFM₁ was 1.9 ng/mg creatinine (Q1–Q3 = 0.82–6.0 ng/mg creatinine), while non-creatinine-adjusted AFM₁ was 0.57 ng/mL (Q1–Q3 = 0.23–1.4 ng/mL). Significantly higher urinary AFM₁ levels were detected in children; age ≤2 years (p = 0.037), who consumed more milk (p = 0.048), and who presented to the nutrition clinic (p = 0.003). These findings highlight the need for an effective control program to reduce the AFM₁ burden in children.

Keywords:

• Aflatoxin
• urinary AFM₁
• Pakistan
• risk factors
• children
• ELISA

Acknowledgements

The authors are thankful to the children and their parents/guardians for their cooperation during the study. The authors thank the Higher Education Commission, Islamabad, Pakistan for providing Ph.D. fellowship to Ms Waseela Ashraf under the indigenous scholarship program [Ref. No. 315-5071-2BS3-061(50034121)]. This research paper is a part of her PhD work.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was funded by the Higher Education Commission (HEC), Pakistan.