Aflatoxins and kwashiorkor: clinical studies in Sudanese children

Abstract

Aflatoxin analysis of blood and urine by high performance liquid chromatography in 584 Sudanese children is reported. The results in 404 malnourished children comprising 141 kwashiorkor, 111 marasmic kwashiorkor and 152 with marasmus are compared with 180 age-matched controls and correlated with clinical findings. The aflatoxin detection rate and mean concentration were higher in serum of children with kwashiorkor than the other groups. The difference between the detection rate in kwashiorkor and controls was significant (p less than 0.05). The aflatoxin detection rate in urine was highest in the marasmic kwashiorkor group and the mean concentration was higher in the marasmic kwashiorkor and marasmic groups than in the kwashiorkor and control groups. There were important differences in the detection of certain aflatoxins between the groups. Aflatoxicol was detected in the sera of 16 (11.6%) kwashiorkor, in six (6.1%) marasmic kwashiorkor, but in none of the controls and only once in marasmus. These differences are highly significant (p less than 0.0001). The ratio of AFB1 to AFM1 was higher in the sera and urines of kwashiorkors than in controls, suggesting that the normal transformation of AFB1 to AFM1 may be impaired in kwashiorkor with consequent increase in transformation of AFB1 to aflatoxicol. The study therefore provides evidence of differences in the metabolism of aflatoxins in children with kwashiorkor compared with children with other forms of malnutrition and normally nourished children and confirms the association between aflatoxins and kwashiorkor contained in a preliminary report on this work.

Aflatoxin Contamination in Foods and Feeds: A Special Focus on Africa

“…Because of the liver's involvement, it was suggested that AFB 1 may be involved (Hendrickse et al, 1983). This appeared to be supported by other observation, e.g., relating peak prevalence for kwashiorkor with climatic conditions such as high humidity (de Vries and Hendrickse, 1988); general occurrence of AFB 1 in children's excreta (de Vries et al 1987(de Vries et al , 1990; liver (Lamplugh and Hendrickes, 1982); serum (Coulter et al, 1986;Hatem et al, 2005); and its reduced product, aflatoxicol, in livers of Ghanaian children (Apeagyei et al, 1986).…”

Oedematous malnutrition

“…Also rejecting protein deficiency, Hendrikse 38 proposed that kwashiorkor was due to aflatoxin poisoning because he found higher circulating levels of aflatoxin in kwashiorkor than marasmus. However, these results are more likely to be explained by the liver dysfunction and failure to metabolise aflatoxin in kwashiorkor, because the excretion of aflatoxicol in the urine is the same in the two conditions 39 . Liver samples sent to Hendrikse from Jamaica for blind analysis did not support this aetiology (Table 1).…”

The Molecular Epidemiology of Chronic Aflatoxin Driven Impaired Child Growth

“…There are several other studies of some note with respect to aflatoxin and birth outcomes with several showing significant negative correlations between birth anthropometry or child undernutrition and aflatoxin measures in biofluids [32–34, 38, 41, 42, 62, 133, 134], whilst one reported study found no statistically significant associations [135]. Importantly, this current set of studies used only “aflatoxin biomeasures” and none of these studies used validated exposure biomarker (AF-albumin in sera, AF-N7-Guanine in urine, nor AFM1 in urine) to assess the level of aflatoxin exposure; thus, quantitative relationships between the biomeasure and exposure outcome are not straightforward to interpret.…”