World Health Organization estimates of the global and regional disease burden of four foodborne chemical toxins, 2010: a data synthesis

Abstract

Background Chemical exposures have been associated with a variety of health effects; however, little is known about the global disease burden from foodborne chemicals. Food can be a major pathway for the general population’s exposure to chemicals, and for some chemicals, it accounts for almost 100% of exposure. Methods and Findings Groups of foodborne chemicals, both natural and anthropogenic, were evaluated for their ability to contribute to the burden of disease. The results of the analyses on four chemicals are presented here - cyanide in cassava, peanut allergen, aflatoxin, and dioxin. Systematic reviews of the literature were conducted to develop age- and sex-specific disease incidence and mortality estimates due to these chemicals. From these estimates, the numbers of cases, deaths and disability adjusted life years (DALYs) were calculated. For these four chemicals combined, the total number of illnesses, deaths, and DALYs in 2010 is estimated to be 339,000 (95% uncertainty interval [UI]: 186,000-1,239,000); 20,000 (95% UI: 8,000-52,000); and 1,012,000 (95% UI: 562,000-2,822,000), respectively. Both cyanide in cassava and aflatoxin are associated with diseases with high case-fatality ratios. Virtually all human exposure to these four chemicals is through the food supply. Conclusion Chemicals in the food supply, as evidenced by the results for only four chemicals, can have a significant impact on the global burden of disease. The case-fatality rates for these four chemicals range from low (e.g., peanut allergen) to extremely high (aflatoxin and liver cancer). The effects associated with these four chemicals are neurologic (cyanide in cassava), cancer (aflatoxin), allergic response (peanut allergen), endocrine (dioxin), and reproductive (dioxin).

Chronic and Acute Toxicities of Aflatoxins: Mechanisms of Action

“…Africa and Asia continue to be the leading continents in terms of new cases recorded each year, with 64,779 (7.7%) and 609,596 (72%) cases respectively, together representing about 80% of the total cases in the world. Aflatoxin B1 alone was estimated to cause 25,200 to 155,000 cases each year [10,11], 40% of which occur in sub-Saharan Africa only [2] where aflatoxin-induced liver cancer accounts for one-third of all liver cancer cases recorded in the whole African continent [12]. At the country level, China has the highest incidence of liver cancer in the world, with the vast majority being recorded in the Southern part of the country where the two main synergistic causative agents, exposure to dietary aflatoxins and HB chronic infections, are endemic and highest [3].…”

Microbiological safety of ready‐to‐eat foods in low‐ and middle‐income countries: A comprehensive 10‐year (2009 to 2018) review

“…On the other hand, continuous daily exposure to single or mixtures of these food contaminants via consumption of contaminated RTEs could produce a plethora of adverse health effects. Observable effects may range from mild to recurrent nausea, vomiting, and diarrhea (Ceuppens et al., ) to severe complications such as cancers, neural tube defects, and even human fatalities (Gibb et al., ; IARC, ; JECFA, , ; Kamala et al., ; Wild & Gong, ). Thus, improperly prepared RTEs in LMICs, where regulations and monitoring for compliance are grossly inadequate, may constitute a huge risk to public health.…”

Piperine inhibits aflatoxin B1 production in Aspergillus flavus by modulating fungal oxidative stress response

“…To date, it is estimated that at least 500 million of people living in sub-Saharan Africa, Latin America and Asia, are exposed to increasing levels of mycotoxins, including aflatoxins, through contaminated commodities (Pitt et al, 2012). In 2010, analysis of several foodborne chemicals by the Chemical and Toxins Disease Task Force reported that aflatoxin was associated with the highest number of DALYs (deaths and disability adjusted life years) (636,869) where one DALY represents the sum of years lived with disability and years of life lost (Gibb et al, 2015). Worryingly, surveys demonstrated that higher levels of aflatoxins in agricultural commodities were linked to upraising climatic conditions (Streit et al, 2013).…”