Aflatoxin exposure and health impacts: global burden and advances in detection technologies

Aflatoxins are food contaminants that cause exposure and adverse health effects and are detected using modern analytical methods. This review summarizes global aflatoxin exposure levels, exposure routes, associated health effects, and detection technologies.

This narrative review was guided by the Scale for the Assessment of Narrative Review Articles (SANRA) framework. Relevant literature was retrieved from PubMed, Scopus, Web of Science, and Google Scholar. Studies addressing aflatoxin exposure, health effects, and detection technologies were included and qualitatively synthesized.

This review showed that in Côte d'Ivoire, peanut paste had 100% AFB1 contamination, with levels of 4535 µg/kg (AFB1) and 8094 µg/kg (total aflatoxins), and 99% of samples exceeded European Union limits. Dietary intake is the main route of exposure (0.3-180 ng/kg/day), with additional exposure via prenatal transfer, breastfeeding (0.01-0.55 ng/mL AFM1), and complementary feeding. Biomarkers show high aflatoxin exposure: 97% (Malaysia) and 94% (pregnant women in Nepal; 0.45-2939.30 pg/mg). Aflatoxin exposure is responsible for 4.6-28.2% of global hepatocellular carcinoma cases, contributes to approximately 250,000 deaths annually, and is associated with a 2-4-fold higher risk of cancer in children. High-performance liquid chromatography coupled with fluorescence detection (HPLC-FLD) is widely used, while Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is the gold standard (< 1 ng/mL). Electrochemical immunosensors reach 0.3 pg/mL, and lateral flow assays provide rapid but less sensitive screening.

Aflatoxin exposure is a major global public health concern. Improved detection methods and food safety measures are essential to reduce exposure and disease burden.