Application of Probabilistic Modeling to Quantify the Reduction Levels of Hepatocellular Carcinoma Risk Attributable to Chronic Aflatoxins Exposure

Wambui, Joseph; Karuri, Edward G.; Ojiambo, Julia A.; Njage, Patrick Murigu Kamau

doi:10.1080/01635581.2017.1247892

Cited by 11 publications

(11 citation statements)

References 72 publications

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“…This thus shows that AFM 1 from milk consumption contributes very little to the annual incidence rate for liver cancer. In general, the incidence rates for HCC reported here are comparable to estimates for Gambia [18] but relatively lower than those reported from a risk assessment in Kenya based on aflatoxin exposure from groundnuts [32] and maize [18]. The latter study reported an incidence rate of 29.2 and 11 cancers per year per 100,000 population from maize collected from rural markets and commercial markets, respectively.…”

Section: Discussionsupporting

confidence: 65%

Aflatoxin Exposure from Milk in Rural Kenya and the Contribution to the Risk of Liver Cancer

Sirma

Makita

Senerwa

et al. 2019

Toxins

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Milk is an important commodity in Kenya; the country has the largest dairy herd and highest per capita milk consumption in East Africa. As such, hazards in milk are of concern. Aflatoxin M1 (AFM1) is a toxic metabolite of aflatoxin B1 (AFB1) excreted in milk by lactating animals after ingesting AFB1-contaminated feeds. This metabolite is injurious to human health, but there is little information on the risk to human health posed by AFM1 in milk in rural Kenya. To fill this gap, a quantitative risk assessment (QRA) applying probabilistic statistical tools to quantify risks was conducted. This assessed the risk of liver cancer posed by AFM1 in milk, assuming 10-fold lower carcinogenicity than AFB1. Data from four agro–ecological zones in Kenya (semi-arid, temperate, sub-humid and humid) were used. We estimated that people were exposed to between 0.3 and 1 ng AFM1 per kg body weight per day through the consumption of milk. The annual incidence rates of cancer attributed to the consumption of AFM1 in milk were 3.5 × 10−3 (95% CI: 3 × 10−3–3.9 × 10−3), 2.9 × 10−3 (95% CI: 2.5 × 10−3–3.3 × 10−3), 1.4 × 10−3 (95% CI: 1.2 × 10−3–1.5 × 10−3) and 2.7 × 10−3 (95% CI: 2.3 × 10−3–3 × 10−3) cancers per 100,000 in adult females, adult males, children 6–18 years old, and in children less than five years old, respectively. Our results show that aflatoxin exposure from milk contributes relatively little to the incidence of liver cancer. Nonetheless, risk managers should take action based on cumulative exposure from all sources of aflatoxins.

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Section: Discussionsupporting

confidence: 65%

Aflatoxin Exposure from Milk in Rural Kenya and the Contribution to the Risk of Liver Cancer

Sirma

Makita

Senerwa

et al. 2019

Toxins

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“…The first recorded acute human aflatoxicosis outbreak in Kenya occurred in 1981 involving 12 fatalities (Ngindu et al, 1982), while the second occurred in the 2004-2005 cropping season (Lewis et al, 2005) with both incidents occurring in lower eastern Kenya. High aflatoxins concentrations in food, serum aflatoxin B 1 -lysine adduct concentrations and positive hepatitis B surface antigen titres have been identified as risk indicators for aflatoxicosis and hepatocellular carcinoma in Kenyan populations (Azziz-Baumgartner et al, 2005;Wambui et al, 2016a).…”

Section: Aflatoxins and Healthmentioning

confidence: 99%

Prevalence and mitigation of aflatoxins in Kenya (1960-to date)

Mutegi

Cotty

Bandyopadhyay

2018

WMJ

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Aflatoxins are highly toxic metabolites of several Aspergillus species widely distributed throughout the environment. These toxins have adverse effects on humans and livestock at a few micrograms per kilogram (μg/kg) concentrations. Strict regulations on the concentrations of aflatoxins allowed in food and feed exist in many nations in the developing world. Loopholes in implementing regulations result in the consumption of dangerous concentrations of aflatoxins. In Kenya, where ‘farm-to-mouth’ crops become severely contaminated, solutions to the aflatoxins problem are needed. Across the decades, aflatoxins have repeatedly caused loss of human and animal life. A prerequisite to developing viable solutions for managing aflatoxins is understanding the geographical distribution and severity of food and feed contamination, and the impact on lives. This review discusses the scope of the aflatoxins problem and management efforts by various players in Kenya. Economic drivers likely to influence the choice of aflatoxins management options include historical adverse health effects on humans and animals, cost of intervention for mitigation of aflatoxins, knowledge about aflatoxins and their impact, incentives for aflatoxins safe food and intended scope of use of interventions. It also highlights knowledge gaps that can direct future management efforts. These include: sparse documented information on human exposure; few robust tools to accurately measure economic impact in widely unstructured value chains; lack of long-term impact studies on benefits of aflatoxins mitigation; inadequate sampling mechanisms in smallholder farms and grain holding stores/containers; overlooking social learning networks in technology uptake and lack of in-depth studies on an array of aflatoxins control measures followed in households. The review proposes improved linkages between agriculture, nutrition and health sectors to address aflatoxins contamination better. Sustained public awareness at all levels, capacity building and aflatoxins related policies are necessary to support management initiatives.

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“…AFM 1 was detected in 100% of the breast milk samples in Kenya and the PDI was estimated in the range of 1.13 to 66.79 ng/kg bw per day for the infants (Wambui, Karuri, Ojiambo, & Njage, 2017). In Egypt, AFM 1 was detected in 65% of the breast milk samples above 0.05 µg/L of 150 mothers of infants fed exclusively on breast milk.…”

Section: Resultsmentioning

confidence: 99%

“…Wambui et al. (2017) estimated that reductions in the occurrence of HCC among rural dwellers in Kenya could be achieved through combinations of various agronomic measures, such as the use of farmyard manure, lime in groundnut, and the use of nonaflatoxigenic strains.…”

Section: Resultsmentioning

confidence: 99%

The aflatoxin situation in Africa: Systematic literature review

Meijer

Kleter

Nijs

et al. 2021

Comp Rev Food Sci Food Safe

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Contamination of African staple foods is a major issue for human and animal health, nutrition, and trade. This review aimed to collect and synthesize the available evidence on geographical spread, scale of contamination, disease burden, economic impact, and mitigation measures for aflatoxins in Africa by way of a systematic literature review. This knowledge can enhance management strategies for the major challenges to combat aflatoxins. The search was conducted by applying a predefined search strategy, using bibliographic databases and websites, covering the period 2010 to 2018. Results showed that maize, peanuts, and animal feeds were the most studied commodities. For maize, all studies indicated mean AFB1 to exceed the European Union legal limit. From studies on contamination levels and biomarkers, it is clear that overall exposure is high, leading to a substantial increase in long‐term disease burden. In addition, concentrations in food occasionally can reach very high levels, causing acute aflatoxicoses. The trade‐related impact of aflatoxin contamination was mainly evaluated from the standpoint of aflatoxin regulation affecting products imported from Africa. There was a limited number of studies on health‐related economic impacts, pointing out a gap in peer‐reviewed literature. A number of mitigation measures have been developed, but proof of cost‐effectiveness or even costs alone of the practices is often lacking. We recommend more emphasis to be put in peer‐reviewed studies on evidence‐based cost‐effective mitigation strategies for aflatoxins, on the scale and spread of the problem and its impacts on public health and economics for use in evidence‐based policies.

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Application of Probabilistic Modeling to Quantify the Reduction Levels of Hepatocellular Carcinoma Risk Attributable to Chronic Aflatoxins Exposure

Cited by 11 publications

References 72 publications

Aflatoxin Exposure from Milk in Rural Kenya and the Contribution to the Risk of Liver Cancer

Aflatoxin Exposure from Milk in Rural Kenya and the Contribution to the Risk of Liver Cancer

Prevalence and mitigation of aflatoxins in Kenya (1960-to date)

The aflatoxin situation in Africa: Systematic literature review

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