Stochastic health risk assessment of aflatoxin M₁ in cow's milk among Lebanese population

This study quantitatively assessed AFM₁ exposure through consumption of cows' milk in Lebanese adolescents and adults. Lebanon-specific, non-aggregated data on (i) milk intake and body weight - from an existing survey for adults and from a new survey for adolescents, and (ii) AFM₁ occurrence in milk, were fitted to distributions and incorporated into a probabilistic model. Risk of hepatocellular carcinoma (HCC) for milk consumers was estimated considering the incidence of hepatitis B virus in Lebanon and characterized using the margin of exposure (MOE). All subgroups' mean risk estimates, expressed as additional HCC cases per 100 000 population per year, were significantly different (p < 0.05), and ranged from 2.2x10^-4 for adult males to 4.9x10^-4 for adolescent males. This variation is attributed to significant differences in body weight and milk intake. MOE identified adolescent males and females as at-risk populations (mean 9628 and 8108, respectively). For adults, levels of concern were only reached with extreme consumption and/or contamination events. Considering that exposure from other sources (e.g., dairy) is cumulative, control of AFM₁ in milk in Lebanon should be a risk management priority to ensure protection of younger populations.