Mycotoxin exposure and infant and young child growth in Africa: what do we know?
1Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom, South Africa.
Insights
Infant exposure to mycotoxins like aflatoxin (AF) is linked to growth impairment in Africa. High AF exposure is associated with stunting and wasting, necessitating further research on other mycotoxins.
Area of Science:
- Environmental Health
- Pediatric Nutrition
- Toxicology
Background:
- Infant and young child (IYC) growth impairment is a significant public health issue in Africa.
- Early-life exposure to mycotoxin-contaminated staple foods contributes to IYC growth problems.
- Understanding the impact of mycotoxins on IYC growth is crucial for developing interventions.
Purpose of the Study:
- To systematically review the existing knowledge on mycotoxin exposure and its effects on IYC growth in Africa.
- To identify the prevalence and levels of mycotoxin exposure in African infants and young children.
- To assess the association between mycotoxin exposure and growth parameters in IYC.
Main Methods:
- Systematic literature search for studies on African IYC mycotoxin exposure and/or growth.
- Inclusion criteria focused on IYC (under 15 years), mycotoxin exposure rates, and growth data; exclusion of animal studies and other mycotoxins.
- Analysis of ten selected studies, primarily focusing on aflatoxin (AF) and fumonisin (FB), with limited data on deoxynivalenol (DON) and zearalenone (ZEA).
Main Results:
- High prevalence (up to 100%) and levels of aflatoxin (AF) exposure were observed in African IYC, with placental transfer and correlation between maternal and breast milk levels.
- Maternal AF exposure was significantly associated with lower height-for-age (HAZ) and weight-for-age (WAZ) z-scores in infants.
- Fumonisins (FB) exposure above tolerable daily intake levels was linked to reduced height and weight in IYC; DON and ZEA roles remain unstudied.
Conclusions:
- Limited epidemiological data reveal extreme AF exposures in African IYC, strongly associated with stunting and wasting.
- Urgent need for more extensive epidemiological research to elucidate the impact of fumonisins, deoxynivalenol, and zearalenone on IYC growth.
- Findings underscore the critical public health threat posed by mycotoxins to early childhood development in Africa.
Introduction:
Infant and young child (IYC) growth impairment remains a public health problem in Africa partly because infants are exposed to staple foods (contaminated with mycotoxins) at an early age. Understanding the role of mycotoxins in IYC growth is vital, and this paper systematically reviews the available knowledge.
Methods:
Studies were searched and included if they provided information on African IYC mycotoxin exposure rates and/or growth. Studies were excluded if subjects were older than 15 years, if they were animal studies or focusing on other mycotoxins. Relevant search words were included in search strings. Eight reviews were identified and reference lists scrutinised for additional studies.
Results:
Ten studies were included; 8 focused on aflatoxin (AF), 2 on fumonisin (FB) and none on deoxynivalenol (DON) and zearalenone (ZEA). AF exposure prevalence reached 100% with levels at 40.4 pg/mg. AF was present in umbilical cords indicating that AF crosses the placenta. Maternal exposure levels were correlated with breast milk levels. The highest levels of serum AF (mean 32.8 pg/mg) were measured in Benin and Togo with 5.4% reaching levels higher than 200 pg/mg. At the end of weaning, children had similar prevalence and exposure levels as adults. RESULTS also indicated that infants with higher levels of maternal exposure had significantly lower height-for-age z-scores (HAZ scores), although there was no significant association between cord AF and infant HAZ scores or AF in cord blood and HAZ scores. Significantly higher mean maternal AF levels related to lower weight-for-age z-scores (WAZ scores) were reported, and infants with higher levels of maternal exposure had significantly lower WAZ scores that decreased over age. Cord AF levels had no effect on infant WAZ scores. One study investigated the association between FB and IYC growth and found that those with FB intakes greater than the provisional maximum tolerable daily intake were significantly shorter (1.3 cm) and lighter (328 g). No studies investigated the role of DON and ZEA.
Conclusion:
A limited number of epidemiological studies have been conducted, and available research indicates extreme exposures to AF. There are strong associations between AF exposure and stunting and wasting. However, more epidemiological research is urgently needed to understand the role of FB, DON and ZEA in IYC growth.
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