Investigating Aflatoxins in Body Fluids and Food of Nigerian Children with Protein- Energy Malnutrition

Aflatoxins are natural contaminants of food crops implicated in the pathogenesis of various human
diseases. Aflatoxins are natural contaminants of food crops such as cereals, oilseeds, spices, and
tree nuts as well as milk, meat, and dried fruit. Acute and chronic exposures to aflatoxins have been
linked to various deleterious health effects such as hepatotoxicity, liver cancers, infertility, malnutrition,
growth retardation and immunosuppression. In Nigeria, close to 30% of children below 5 years are
malnourished [12] but studies suggesting a possible role of aflatoxin in PEM were based only on
detection of high concentration of aflatoxins in autopsy lung, kidney and liver specimens from children
who died from kwashiorkor. This study aimed to determine the associations between aflatoxins and
protein- energy malnutrition (PEM) by measurements of aflatoxins in serum, urine and food on plate of
Nigerian children with PEM. A cross- sectional study was undertaken in 3 agro- ecological regions of
Nigeria (Guinea savannah, Sudan savannah and Rain forest), where aflatoxins B1, B2, G1, G2, M1,
and M2 were measured in sera, urine and food on plate of 79 children with PEM (kwashiorkor n=36,
marasmic kwashiorkor n=29 and marasmus n=13) and 33 healthy controls, matched for age and sex.
Among healthy controls, aflatoxin detection rates were higher in the Guinea Savannah (72.2%) than in
the Sudan Savannah (53.8%), albeit statistically insignificant. In relation to nutritional groups, the rates
of detection of aflatoxins were higher in marasmic kwashiorkor (93.1%) and kwashiorkor patients
(88.9%), compared to marasmus (76.9%) and controls (63.6%, p=0.013). The rates of detection of
B1 aflatoxin followed a similar trend viz. marasmic kwashiorkor (82.4%), kwashiorkor (69.4%),
marasmus (53.8%) and controls (42.4%, p=0.007). Of all types of aflatoxins detected in serum, M2
had the highest rates of detection in all patient groups and controls. The median concentrations of
aflatoxins detected in sera of each PEM group were significantly higher than those of controls, but
comparisons between PEM groups were not statistically significant. The frequency and concentration
of aflatoxins detected in urine and food of PEM groups and controls were not statistically different.
However, controls had the lowest serum /urine aflatoxin ratio as well as lowest median aflatoxins
concentrations in their food as compared to PEM patients. In conclusion, aflatoxins are commonly
detected in the body fluids and food of Nigerian children, but more frequently and at higher
concentrations in children with PEM, possibly due to decreased excretion or increased exposure.
Future prospective studies are desirable to determine if aflatoxins contribute to the pathogenesis of all
types of PEM and not necessarily kwashiorkor alone.