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

Area of Science:

• Environmental Health
• Toxicology
• Pediatrics

Background:

• Aflatoxins are potent carcinogenic and immunomodulatory mycotoxins linked to adverse health outcomes.
• Aflatoxin M1 (AFM1) in urine serves as a biomarker for exposure to aflatoxins, primarily through contaminated food sources like milk.
• Childhood exposure to mycotoxins is a significant public health concern, necessitating investigation into exposure levels and risk factors.

Purpose of the Study:

• To detect aflatoxin M1 (AFM1) in the urine of children as a biomarker of exposure.
• To determine the prevalence of AFM1 exposure in children attending a specialized-childcare hospital in Lahore.
• To identify potential risk factors associated with AFM1 exposure in the pediatric population.

Main Methods:

• Urine samples were collected from 238 children aged 1-11 years during different seasons (winter and hot-humid summer).
• Enzyme-Linked Immunosorbent Assay (ELISA) was employed to test for the presence of AFM1 in urine samples.
• Data on potential risk factors, including age, living area (urban/rural), milk consumption, and clinic visits, were collected and analyzed.

Main Results:

• A high prevalence of urinary AFM1 was observed, with 65.5% (156 out of 238) of samples testing positive.
• AFM1 positivity was significantly higher during hot-humid months (74.6%) compared to winter (57.3%), and in urban (71.1%) versus rural (58.3%) children.
• Elevated AFM1 levels were associated with younger children (≤2 years), higher milk consumption, and visits to the nutrition clinic.

Conclusions:

• The study highlights a substantial burden of AFM1 exposure among children in Lahore, Pakistan.
• Seasonal variations and living environment (urban vs. rural) are significant factors influencing AFM1 exposure.
• Targeted interventions and control programs are crucial to mitigate AFM1 exposure and protect children's health.