The Potential Role of Mycotoxins as a Contributor to Stunting in the SHINE Trial

Abstract

Children in developing countries experience multiple exposures that are harmful to their growth and development. An emerging concern is frequent exposure to mycotoxins that contaminate a wide range of staple foods, including maize and groundnuts. Three mycotoxins are suspected to contribute to poor child health and development: aflatoxin, fumonisin, and deoxynivalenol. We summarize the evidence that mycotoxin exposure is associated with stunting, and propose that the causal pathway may be through environmental enteric dysfunction (EED) and disturbance of the insulin-like growth factor 1 (IGF-1) axis. The objectives of this substudy are to assess the relationship between agricultural and harvest practices and mycotoxin exposure; to evaluate associations between mycotoxin exposure and child stunting; and to investigate EED as a potential pathway linking mycotoxin exposure to child stunting, to inform potential areas for intervention.

Determinants of recent aflatoxin exposure among pregnant women in rural Zimbabwe

“…These findings suggest that while postharvest toxin accumulation is an important contributor to household exposure, the levels of exposure at harvest might indicate the importance of preharvest toxin accumulation. Pre‐ and postharvest practices could be important determinants of AF exposure at the household level . We did not explore these factors because of the short‐term nature of AFM1 compared to potentially long‐term recollections of the previous harvest season (up to 11 months prior).…”

“…postharvest practices could be important determinants of AF exposure at the household level [63]. We did not explore these factors because of the short-term nature of AFM1 compared to potentially long-term recollections of the previous harvest season (up to 11 months prior).…”

Environmental Health Research in Africa: Important Progress and Promising Opportunities

“…Mycotoxins, particularly aflatoxin and fumonisins, are natural toxins that many people in Africa are exposed to because they contaminate the staple diet of groundnuts, maize, and other cereals (Darwish et al, 2014). Aflatoxin in particular (which is produced by the fungi Aspergillus flavus and Aspergillus parasiticus) (Afum et al, 2016) is established as a cause of cirrhosis and human liver cancer (hepatocellular carcinoma-HCC) and growth faltering (perhaps due to micronutrient deficiencies) in young children (Obuseh et al, 2011;Bosetti et al, 2014;Shirima et al, 2015;Smith et al, 2015;Wirth et al, 2017). Adverse birth outcomes and anemia in pregnant women and acute aflatoxin poisoning in Africa are also concerns (Kimanya et al, 2010;Shuaib et al, 2010a;Shuaib et al, 2010b;Wild and Gong, 2010;Khlangwiset et al, 2011;Hoffmann et al, 2015).…”

Nutrient and mycotoxin content of commercially-sold premixed infant cereals in Malawi

“…Given their intake per unit of body weight, infants and young children are at a higher risk of experiencing the adverse health effects associated with mycotoxin exposure. Mycotoxin exposure is associated with poor child growth and stunting, although recent studies have highlighted the complicated nature of the relationship and the need for more research (Gong, Watson, and Routledge 2016;Egal et al 2005;Smith et al 2015;Lombard 2014;Mupunga, Mngqawa, and Katerere 2017;Kiarie et al 2016;Hoffmann, Jones, and Leroy 2018). Exposure in utero, via breastmilk, or in complementary and family foods can limit child development through various pathways, for example through environmental enteropathy or impaired immune system function (Leroy and Frongillo 2019;Smith, Stoltzfus, and Prendergast 2012).…”