Aflatoxin exposure and mortality in acutely ill children: results from the CHAIN network cohort
Lei Xia1, Hang Wu2, Ali Faisal Saleem3
1School of Food Science & Nutrition, University of Leeds Faculty of Engineering and Physical Sciences, Leeds, West Yorkshire, UK.
Insights
Aflatoxin exposure is linked to mortality in non-wasted, acutely ill children. Malnutrition poses a greater risk, but controlling aflatoxin exposure is crucial for public health interventions.
Area of Science:
- Environmental Health
- Pediatric Health
- Toxicology
Background:
- Chronic aflatoxin exposure is linked to liver cancer, impaired child growth, and immune dysfunction.
- The Childhood Acute Illness and Nutrition (CHAIN) Network cohort studied risk factors for mortality in acutely ill children in Africa and South Asia.
- This study investigated the role of aflatoxin exposure in inpatient and post-discharge mortality.
Purpose of the Study:
- To assess the association between aflatoxin exposure and mortality in acutely ill children.
- To evaluate aflatoxin-albumin adduct (AF-alb) levels in relation to nutritional status and mortality outcomes.
Main Methods:
- A nested case-cohort study within the CHAIN cohort.
- Serum samples from hospitalized children (n=755) and community participants (n=222) were analyzed for AF-alb using ELISA.
- Children were stratified by nutritional status (non-wasting, medium-wasting, severe-wasting).
Main Results:
- 56% of hospitalized children tested positive for AF-alb at admission.
- Higher AF-alb levels were observed in deceased children compared to survivors and community participants.
- Aflatoxin exposure was significantly associated with mortality in non-wasted children (OR=4.84, p=0.014).
Conclusions:
- Moderate to severe malnutrition is a more significant risk factor for mortality than aflatoxin in acutely ill children.
- Aflatoxin exposure may contribute to mortality specifically in non-wasted children.
- Integrating aflatoxin exposure control into public health interventions is recommended in high-exposure areas.
Background:
Chronic exposure to aflatoxins is associated with liver cancer, impaired child growth, and compromised immune function. The Childhood Acute Illness and Nutrition (CHAIN) Network cohort was established to identify risk factors for mortality in acutely ill children admitted to nine hospitals in four African and two South Asian countries. We examined the role of aflatoxin exposure in inpatient and post-discharge mortality.
Methods:
In a nested case-cohort from the CHAIN cohort, we compared aflatoxin exposure at admission and discharge with death or survival in hospital (n=755) or up to 180-days post-discharge (n=585) and with community participants (CP, n=222). Children were stratified into non-wasting, medium-wasting and severe-wasting groups based on mid-upper arm circumference. Serum samples were analysed for an aflatoxin exposure biomarker, the aflatoxin-albumin adduct (AF-alb) using ELISA.
Findings:
Overall, 56% of hospitalised participants tested positive for AF-alb at admission. The AF-alb level was higher in deceased (geometric mean and 95% CI (GM and 95% CI) 5.9 (4.9 to 7.1)) than in survivors (4.2 (3.8 to 4.7)) and CP (3.7 (3.1 to 4.3)) pg/mg alb. AF-alb concentration was higher at admission (4.7, (4.2 to 5.1)) than at discharge (3.7, (3.3 to 4.1)) and in the CP group (3.7, (3.1 to 4.3)) pg/mg alb (p<0.01) and in African vs Asian children (7.4 (6.5 to 8.5) vs 1.9 (1.8 to 2.1)) (p<0.001). Adjusted logistical regression showed no significant association between AF-alb levels and mortality, but after separating the nutrition strata, AF-alb was significantly associated with mortality (highest vs lowest quartile group OR=4.84, p=0.014) in non-wasted children.
Interpretation:
Moderate to severe malnutrition is a more important risk factor for mortality than aflatoxin in acutely ill children, but aflatoxin exposure may contribute to mortality in non-wasted children. Controlling aflatoxin exposure should be integrated into clinical and public health interventions to reduce mortality in areas with high levels of exposure.
Funding:
Bill and Melinda Gates Foundation (OPP1131320 & INV-003225).
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