Association between aflatoxin-albumin adduct levels and tortilla consumption in Guatemalan adults

Kroker-Lobos, María F; Álvarez, Christian S.; Rivera-Andrade, Álvaro; Smith, Joshua W.; Egner, Patricia A.; Torres, Olga; Lazo, Mariana; Freedman, Neal D.; Güallar, Eliseo; Graubard, Barry I.; McGlynn, Katherine A.; Ramírez‐Zea, Manuel; Groopman, John D.

doi:10.1016/j.toxrep.2019.05.009

Cited by 22 publications

(14 citation statements)

References 34 publications

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“…3 In addition, our group has found that the most important source of AFB 1 exposure in the population was consumption of tortillas, a primary staple in the Guatemalan diet. 16 This finding was consistent with prior evidence of high AFB 1 levels in maize samples across the country. 17 The current study was designed to assess the association between AFB 1 and cirrhosis in Guatemala.…”

Section: What Are the New Findings?supporting

confidence: 89%

Aflatoxin B₁exposure and liver cirrhosis in Guatemala: a case–control study

Álvarez

Hernández

Escobar

et al. 2020

BMJ Open Gastroenterol

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ObjectiveIn Guatemala, cirrhosis is among the 10 leading causes of death, and mortality rates have increased lately. The reasons for this heavy burden of disease are not clear as the prevalence of prominent risk factors, such as hepatitis B virus, hepatitis C virus and heavy alcohol consumption, appears to be low. Aflatoxin B1 (AFB1) exposure, however, appears to be high, and thus could be associated with the high burden of cirrhosis. Whether AFB1 increases the risk of cirrhosis in the absence of viral infection, however, is not clear.DesignCirrhosis cases (n=100) from two major referral hospitals in Guatemala City were compared with controls (n=200) from a cross-sectional study. Logistic regression was used to estimate the ORs and 95% CIs of cirrhosis and quintiles of AFB1 in crude and adjusted models. A sex-stratified analysis was also conducted.ResultsThe median AFB1 level was significantly higher among the cases (11.4 pg/mg) than controls (5.11 pg/mg). In logistic regression analyses, higher levels of AFB1 was associated with cirrhosis (quintile 5 vs quintile 1, OR: 11.55; 95% CI 4.05 to 32.89). No attenuation was observed with adjustment by sex, ethnicity, hepatitis B virus status, and heavy alcohol consumption. A significantly increasing trend in association was observed in both models (p trend <0.01). Additionally, the cirrhosis–AFB1 association was more prominent among men.ConclusionsThe current study found a significant positive association between AFB1 exposure and cirrhosis. Mitigation of AFB1 exposure and a better understanding of additional risk factors may be important to reduce the burden of cirrhosis in Guatemala.

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Section: What Are the New Findings?supporting

confidence: 89%

Aflatoxin B₁exposure and liver cirrhosis in Guatemala: a case–control study

Álvarez

Hernández

Escobar

et al. 2020

BMJ Open Gastroenterol

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“…The high levels of AFB 1 reported in Guatemala (8,9) are comparable to the levels found in some high-rate parts of China before the transition there from a maize-based to a rice-based diet. (28) In the current study, there were in total 24 mutations with a G->T transversion. The majority of the G->T transversions occurred in codon 249 and the rest were in codons: 157 (n = 2) and 248 (n = 1) (data not shown).…”

Section: Discussionmentioning

confidence: 70%

Analysis of TP53 gene mutations demonstrates that aflatoxin is a risk factor for hepatocellular carcinoma in Guatemala

Álvarez¹,

Ortiz

Bendfeldt-Avila

et al. 2019

Preprint

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Background Guatemala has the highest incidence of hepatocellular carcinoma (HCC), the dominant type of liver cancer, in the Western Hemisphere. The major risk factors in Guatemala are not well-characterized, but the prevalence of hepatitis B (HBV) and hepatitis C virus (HCV) appear to be low, while the prevalence of aflatoxin (AFB 1 ) exposure appears to be high. To examine whether AFB 1 could be a risk factor for HCC in Guatemala, this study examined the frequency of the AFB 1 -signature mutation in the TP53 gene (R249S) as well as other somatic mutations.Methods Ninety-one formalin-fixed, paraffin-embedded (FFPE) HCC tissues were obtained from three hospitals in Guatemala City. An additional, eighteen tumor tissues preserved in RNAlater were also obtained. Targeted sequencing of TP53 was successfully performed in 89 of the FFPE samples, and a panel of 245 genes were sequenced in the RNAlater samples.Results Overall, 47% of HCCs had a TP53 mutation. The AFB 1 -signature R249S mutation was present in 24%. Among the RNAlater samples, 44% had any TP53 mutation and 33% had the R249S mutation. Other somatic mutations were identified in known HCC driver genes such as ARID1A , ARID2 , and CTNNB1 .Conclusions The presence of the TP53 R249S mutation indicates that AFB 1 is a risk factor for HCC in Guatemala. The proportion of HBV positive tumors was low, suggesting that AFB 1 is associated with HCC in the absence of concomitant HBV infection. To decrease the risk of HCC in Guatemala, AFB 1 abatements efforts are warranted.

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“…In addition to the main analysis, PORs and 95%CIs were estimated to assess associations between total maize and tortilla consumption with each metabolic condition. 26 All tests of significance were two-sided. P-values less than .05…”

Section: Discussionmentioning

confidence: 99%

Associations between aflatoxin B₁‐albumin adduct levels with metabolic conditions in Guatemala: A cross‐sectional study

Álvarez

Rivera-Andrade

Kroker-Lobos

et al. 2022

Health Science Reports

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Background and Aims: Metabolic conditions such as obesity, type 2 diabetes, metabolic syndrome, and nonalcoholic fatty liver disease (NAFLD) are highly prevalent in Guatemala and increase the risk for a number of disorders, including hepatocellular carcinoma (HCC). Aflatoxin B 1 (AFB 1 ) levels are also notably elevated in the population and are known to be associated with HCC risk. Whether AFB 1 also contributes to the high prevalence of the metabolic disorders has not been previously examined. Therefore, the purpose of this study was to assess the association between AFB 1 and the metabolic conditions. Methods: Four-hundred twenty-three individuals were included in the study, in which AFB 1 -albumin adduct levels were measured in sera. Metabolic conditions included diabetes, obesity, central obesity, metabolic syndrome, and NAFLD. Crude and adjusted prevalence odds ratios (PORs) and 95% confidence intervals (95% CI) were estimated for the associations between the metabolic conditions and AFB 1albumin adduct levels categorized into quartiles. Results:The study found a significant association between AFB 1 -albumin adduct levels and diabetes (Q4 vs Q1 POR = 3.74, 95%CI: 1.71-8.19; P-trend .003).

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Association between aflatoxin-albumin adduct levels and tortilla consumption in Guatemalan adults

Cited by 22 publications

References 34 publications

Aflatoxin B₁exposure and liver cirrhosis in Guatemala: a case–control study

Aflatoxin B₁exposure and liver cirrhosis in Guatemala: a case–control study

Analysis of TP53 gene mutations demonstrates that aflatoxin is a risk factor for hepatocellular carcinoma in Guatemala

Associations between aflatoxin B₁‐albumin adduct levels with metabolic conditions in Guatemala: A cross‐sectional study

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Association between aflatoxin-albumin adduct levels and tortilla consumption in Guatemalan adults

Cited by 22 publications

References 34 publications

Aflatoxin B1exposure and liver cirrhosis in Guatemala: a case–control study

Aflatoxin B1exposure and liver cirrhosis in Guatemala: a case–control study

Analysis of TP53 gene mutations demonstrates that aflatoxin is a risk factor for hepatocellular carcinoma in Guatemala

Associations between aflatoxin B1‐albumin adduct levels with metabolic conditions in Guatemala: A cross‐sectional study

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Aflatoxin B₁exposure and liver cirrhosis in Guatemala: a case–control study

Aflatoxin B₁exposure and liver cirrhosis in Guatemala: a case–control study

Associations between aflatoxin B₁‐albumin adduct levels with metabolic conditions in Guatemala: A cross‐sectional study