Workplace exposure to aflatoxins & its health effects: A systematic review

Background & objectives Aflatoxins pose serious health risks to humans and livestock, with ingestion being the most common route of exposure. In occupational settings, workers can also be exposed through inhalation of organic dust and dermal contact. The review aimed to provide an overview of aflatoxin exposure and health effects among workers. Methods Observational studies investigating occupational exposure to aflatoxins and their health effects were systematically screened in PubMed, Embase, and Scopus till June 2024. Studies meeting inclusion criteria, were assessed for their methodological quality using the Newcastle-Ottawa Scale. Results Overall, 12,610 studies were screened of which 17 studies were included in the final review. Food-grain workers, farmers, millers, bakers, grain handlers, oil pressors, and feed mixers, are at a higher risk of occupational exposure to aflatoxins. Assessment of exposure was done by analysing biological fluids (Blood, Urine, and Bronchoalveolar lavage) and samples from the working environment (settled dust, airborne dust, and personal sampling) using enzyme-Linked Immunoassay and High-Performance Liquid Chromatography. Studies have shown an elevation of hepatic and renal enzymes, an increased risk for hepatobiliary cancer, and an increased risk for tumour markers, oxidative markers, and reduced antioxidant levels. One recent study has also found an association between aflatoxin exposure and weight for age and height among children of workers. Interpretation & conclusions Occupational exposure to aflatoxins is associated with hepatic and renal toxicity and increased carcinogenic risk. These findings highlight the need of large scale dose- response studies, workplace monitoring and regular health surveillance among workers.