Aflatoxin M1 in Human Milk in Türkiye: A Systematic Review, Meta-Analysis, and Meta-Regression

Aflatoxin M1 (AFM1), a hydroxylated metabolite of aflatoxin B1, can contaminate human milk through maternal dietary intake, posing potential toxicological and developmental risks for infants. Limited evidence exists regarding regional variations in AFM1 exposure among lactating women in Türkiye.

This study aimed to determine the pooled prevalence and concentration of AFM1 in human milk in Türkiye and to examine regional differences in exposure among lactating women.

This systematic review and meta-analysis, registered in PROSPERO (CRD42022352195), included 13 cross-sectional studies analyzing 1,120 breast milk samples. Data extraction followed the PICOS framework, and study quality was assessed using the EPHPP and modified Cochrane tools. Random-effects meta-analysis and meta-regression were used to estimate pooled prevalence and mean concentration and to explore regional variations.

The mean AFM1 concentration was 6.08 ng/L. The pooled prevalence was 41.0% (95% CI [22.5, 62.4]; I² = 96.27%). The highest positivity rates were found in the Mediterranean (26.5%) and Southeastern Anatolia (25.7%) regions, while the Marmara (4.6%) and Eastern Anatolia (5.3%) regions showed lower levels (p < 0.05). No publication bias was detected.

Although AFM1 levels in human milk in Türkiye are below legal safety limits, the high frequency of exposure and regional disparities highlight the need for strengthened food safety monitoring, improved maternal dietary awareness, and integration of aflatoxin risk education into lactation counseling.