Disease Burden Estimation of Hepatocellular Carcinoma Attributable to Dietary Aflatoxin Exposure in Sichuan Province, China

Aflatoxin B₁ (AFB₁), AFB₂, AFG₁, and AFG₂ are Group 1 human carcinogens, with AFB₁ notably increasing hepatocellular carcinoma (HCC) risk. Sichuan Province, China, with its subtropical monsoon climate, is susceptible to AF contamination in various food items. However, the HCC disease burden attributable to lifetime chronic dietary AF intake in Sichuan has not been investigated.

The contamination data of AFB₁, AFB₂, AFG₁, AFG₂, and AFM₁ across 20 food categories were analyzed from 2012 to 2023 in Sichuan. Along with the consumption data gathered from the 2011 China National Nutrition and Health Survey, the FDA-iRISK simulated the lifetime chronic dietary exposure patterns of ∑₅AF and estimated the associated HCC burden using disability-adjusted life year (DALY) as the metric.

As for the mean AF contamination level in food from Sichuan, the estimated lifetime average daily dose (LADD) of ∑₅AF intake was 9.77 ng/kg bw/day at minimum and 26.0 ng/kg bw/day at maximum, resulting in the lifetime HCC risks per person of 0.106% and 0.283%. The corresponding HCC burdens were 16.87 DALY/100,000 people/year and 44.95 DALY/100,000 people/year, respectively. In the same scenario, the LADD and the risk of HCC in males were higher than in females, but the PAF was higher in females. However, the high (P₉₅) AF contamination level in food caused 2-3 times higher LADD and HCC burden than the mean level of AF occurrence. Among the studied food categories, grains and their products were the primary dietary sources of dietary AF exposure.

Sichuan population's lifetime exposure to ∑₅AF results in an HCC burden higher than the global level. It is recommended to continuously monitor and control AF contamination in Sichuan, particularly those highly vulnerable food categories, and the HCC disease burden should remain a concern in future research efforts.