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Nutrition during the early life cycle

Dietary determinants of aflatoxin B1-lysine adduct among infants in Nepal

European Journal of Clinical Nutrition volume 76, pages 1557–1565 (2022)Cite this article

Subjects

Abstract

Background

Aflatoxins are mycotoxins produced by naturally occurring fungi on food, and aflatoxin B1 (AFB1) is carcinogenic, immunotoxic and hepatotoxic. This study assesses the relationship between AFB1 in Nepali infants at 12 months of age and their diet at 9 and 12 months of age.

Methods

The study used data collected from 1329 infants enrolled in the AflaCohort Study. Aflatoxin exposure was assessed at 12 months using serum AFB1-lysine pg/mg albumin biomarker measured using high performance liquid chromatography-fluorescent detection. Dietary data were collected using food frequency questionnaire. We conducted ordinary least squares and quantile regression analyses with backward elimination to assess lagged (9-month diet and 12-month AFB1) and contemporaneous (12-month diet and 12-month AFB1) associations.

Results

Eighty-one percent of children at 12 months had detectable levels of serum AFB1-lysine (geometric mean: 0.79 pg/mg albumin, 95% CI: 0.74–0.83). The levels ranged from 0.4 to 85 pg/mg albumin. Dietary diversity at 9 and 12 months were not associated with serum AFB1-lysine levels. Consumption of fish and groundnuts at both 9 and 12 months and infant formula and cauliflower at 9 months were associated with higher serum AFB1-lysine while consumption of bananas and mangoes at 12 months were negatively associated with serum AFB1-lysine (p < 0.05).

Conclusions

High prevalence of detectable AFB1-lysine among infants, and possible links to their dietary patterns argues for more urgent research into which foods in children’s diets are most contaminated, and into optimal entry points in the food chain that would allow for effective actions to minimize exposure.

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Fig. 1: Serum AFB1-lysine levels in serum (pg/mg albumin) for 12-month-old children enrolled in the AflaCohort Study.
Fig. 2: Consumption of food groups among children in the past 24 h.

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Data availability

Data described in the manuscript, codebook, and analytic code will be made available upon request pending approval. Data will be made publicly and freely available without restriction at https://data.usaid.gov/ once all manuscripts related to the study’s original research questions have been published in peer-reviewed journals.

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Acknowledgements

The authors express special gratitude to USAID-Nepal Mission, USAID Bureau of Food Security, Dr. Ahmed Kablan, Mr. Debendra Adhikari, Nepalgunj Medical College, District Public Health Office- Banke, Child Health Division, the AflaCohort Study team and the study participants without whom this research would not have been possible.

Funding

Support for this research was provided by the Feed the Future Innovation Lab for Nutrition, which is funded by the United States Agency for International Development (USAID) under grant ID: AID-OAA-L-10-00006 to Tufts University. The opinions expressed herein are solely those of the authors.

Author information

Authors and Affiliations

  1. Feed the Future Innovation Lab for Nutrition, Helen Keller International, Kathmandu, Nepal

    Ashish Lamichhane, Ashish Pokharel, Sudikshya Acharya & Dale Davis

  2. Feed the Future Innovation Lab for Nutrition, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA

    Patrick Webb, Johanna Andrews-Trevino, Robin Shrestha & Shibani Ghosh

  3. Patan Academy of Health Sciences, Lalitpur, Nepal

    Kedar Baral

  4. Department of Environmental Health, University of Georgia, Athens, GA, USA

    Jia-Sheng Wang & Kathy Xue

  5. Kanti Children’s Hospital, Kathmandu, Nepal

    Krishna Paudel

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Contributions

AL: writing—original draft, formal analysis. PW: conceptualization, methodology, project administration, writing—review and editing. JA-T: writing—review and editing, data curation, project administration. AP: writing—review and editing, formal analysis. SA: data curation, writing—review and editing. RS and DD: writing—review and editing, project administration. KB: conceptualization, project administration. JSW: investigation. KX: investigation, writing—review and editing. KP: conceptualization. SG: conceptualization, methodology, formal analysis, project administration, writing—review and editing.

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Correspondence to Ashish Lamichhane.

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Lamichhane, A., Webb, P., Andrews-Trevino, J. et al. Dietary determinants of aflatoxin B1-lysine adduct among infants in Nepal. Eur J Clin Nutr 76, 1557–1565 (2022). https://doi.org/10.1038/s41430-022-01142-1

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