Mycotoxins and child health: the risk analysis paradigm

Mycotoxins are toxic secondary metabolites produced by microscopic fungi that are growing on agricultural commodities. Their frequent presence in food and their severe toxic, carcinogenic and estrogenic properties have been recognized as an important potential threat to human health. Worldwide, mycotoxins cause adverse health effects on humans and animals and economic losses in food crops and animals. Although there are many species of toxigenic moulds, only a few mycotoxins, particularly those affecting cereals and groundnuts, are considered to be significant for humans. Mycotoxins of worldwide public health importance are: aflatoxins, ochratoxins, fumonisins, zearalenone, and trichothecenes. Worldwide, exposure to mycotoxins varies between communities and inside exposed communities. Currently, there is a growing concern within the medical community regarding mycotoxin involvement in human diseases. Children have unique physiological features as they grow, and their sensitivity to chemicals is different from that of adults. Correspondingly, the potentially disproportionate impact that environmental chemical exposures might have on the health of infants, children, and the developing fetus has been given increasing attention over the past two decades. The risk analysis paradigm has been developed by the US academy of science in the 1980s. Risk analysis is made up of three separate parts: risk assessment, risk management and risk communication. Assuring food safety and control of mycotoxins as unavoidable food contaminants relies upon risk analysis providing the scientific basis for integrated management systems to minimize hazards posed by mycotoxins. Epidemiology, toxicology, clinical medicine, and environmental exposure assessment all contribute information for risk assessment. Health risk assessment contributes increasingly to policy development, public health decision making, the establishment of mycotoxin regulations, and research planning. It also often plays an important role in cost-benefit analysis and risk communication. A reliable risk assessment of mycotoxin contamination for humans and animals relies basically on their unambiguous identification and accurate quantification in food and feedstuff. There are gaps of knowledge in the risk analysis process and some associated cause-effect relationship uncertainties Human data are difficult to obtain but once available such data are more reliable than extrapolations from animal data with accompanied uncertainty. New developments in risk analysis methods are primarily implied by associated uncertainty of current assessment methodologies. A constellation of factors can lead to more exposure to mycotoxins in developing than in developed countries. These factors include: climate that is in favor of fungal growth, poor food control and crop trade considerations. In these countries, tremendous numbers of children as vulnerable sub-groups are exposed to mycotoxins. Unfortunately, compared with developed countries, developing countries have less available means for assessing the magnitude of mycotoxins induced risks; or further to mitigate and minimize these risks. That mycotoxins are a likely a significant health hazard calls for deciding on prioritizing the formidable task of assessing the hazardous impact of mycotoxins on child health and every feasible effort should be made to protect children. Precautionary preventive actions should be initiated as a part of the risk management process. Needless to say, risk communication should raise the awareness of mycotoxins induced health hazards

Aflatoxins and child health: towards a strategy for prevention and control

Good child nutrition is a right because it is in the best interests of the child. Food safety is aimed at the prevention and/or reduction of toxicological risks due to food. Aflatoxins are secondary metabolites of the fungi Aspergillus flavus, A. parasiticus and A. nomius. The fungi [best grown in hot humid atmosphere] have a special predilection for peanuts, oil seeds, corn but cereals and almost any other food commodity can be contaminated with aflatoxins. Aflatoxins are unavoidable food contaminants even when good agricultural practices are applied. Crop transfers through international trade have made aflatoxins contaminated food a worldwide problem. Also, aflatoxins are carried over from feed into milk and milk products including cheese and powdered milk, where they appear mainly as aflatoxin M1. Aflatoxins are both acutely and chronically toxic in animals and humans. They produce four distinctive effects; acute liver damage, mutagenesis, teratogenesis and tumor induction [carcinogenesis]. The liver is the main target of aflatoxin toxicity and carcinogenicity. There is ample evidence that aflatoxins produce acute and chronic illness in animals; meanwhile, definitive evidence on the cause and effect relationship of mycotoxins and human diseases is limited. In humans, aflatoxin contaminated food and milk pose a hazardous impact on child health. Transplacental transfer of aflatoxins and aflatoxins in breast milk of mothers who ingest aflatoxin-contaminated food, expose the fetus and young infant to aflatoxins untoward health effects. Epdemiological evidences implicate aflatoxins in the causation of Kwashiorkor, unexplained neonatal jaundice, hepatitis cirrhosis and Reye's syndrome and decreased immunity. The development of practical control and management strategies is therefore essential to ensure child safety. From child health point of view, integrated preventive and control measures for aflatoxin contaminated food should minimize as much as possible mother, fetus, infants and child exposure to aflatoxins during pregnancy, lactation and thought childhood. Effective integrated mycotoxins management programs not only cover prevention of mycotoxins formation in agricultural products or their detoxification/decontamination, but also involve routine surveillance, regulatory measures to control the flow of mycotoxins-contaminated material in national and international trade and information, education and communication activities. Food surveillance and the enforcement of proper safety legalization provide the basis for a control strategy

Aflatoxin exposure in preschool-age children living in Cairo: a pilot study

The aim of this work was to study children exposure to aflatoxins in the preschool age. One hundred Egyptian children living in Cairo city were subjected to this study. The study children were 47 males and 53 females with a mean age of 3.58 +/- 1.72 years. They were randomly selected from apparently healthy children attending the NRC Child Health Clinic in follow up visits during the year 2001. Each child was assessed as regards medical history taking, anthropometric measurements, clinical examination and routine laboratory investigations. Dietary assessment utilizing questionnaires covering 24 hours recall and food consumption during a whole week was performed. Parental consent was taken. A 24 hours urine sample was collected from each child. Detection of aflatoxins or its metabolites in collected urine samples was performed with thin layer chromatography [TLC] and was determined with high performance liquid chromatography [HPLC]. The results obtained showed the presence of one or more aflatoxins [B1, B2, G1, G2, M1, R0, P1] in urine samples of 37% of children.The geometric mean concentration [GM] of total aflatoxins detected was 6.539 ng/dl urine. Aflatoxin B1 was detected in urine samples of 18 children with a geometric mean concentration of 10.792 ng/dl, ranking highest in occurrence and concentration compared to other aflatoxins detected. Children with positive urine samples for aflatoxins were compared with other study children as regards age, sex and clinical data. The differences between these two groups [positive versus negative] data were statistically insignificant. The results obtained were discussed as regards relevant studies in Egypt and in other countries. Data of 24 hours diet recall sheets as regards ingested food items by children with positive urine samples to aflatoxins were compared with counterpart findings in other children. The revealed differences were statistically insignificant. A random distribution of aflatoxin-contaminated food among ingested items was a possible explanation. However, the week diet recall data revealed a statistically significant between the two groups indicating more frequent intakes of animal milk and their products by children with positive urine samples of aflatoxins

Mycotoxins and child health: Of mycotoxicosis and food safety in Egypt; a search

Mycotoxins are toxic secondary metabolites produced by ceratin species of fungi. They have a range of diverse chemical and physical properties and toxicological effects on man and animal. In the ear of globalization, Mycotoxins are by far, the most important contaminatns of the food chain for human health and economy. Aflacions continue to receive major rsearch attention bcause of its high toxicity and carcinogenicity. Fumonisinis, ochratxin A, trichothencese, patulin and zearalenone have gained growing nterest in view of their osed threat to the health of humans and animals. In Egypt, many foods and feeds are not uncommonly contaminated with mycotoxins. These include cereals, nuts, milk and milk products, animal feeds sampled from different regions of Egypt. Immense research efforts are going on to identify and determine the magnitude of these contaminations and potential harads to health. Children are at a particular risk to health hazards posed by mycotoxins because of the likelihood of higher exposure on a body weight basis. In Egypt, available epidemiological data suggest a possible causative role for mycotoxins in some liver and rnal disorders in children and adults. Maternal and child health, neonatal diseases, protein energy malnutrition are repeatedly studied in relation to mycotoxins. While complete elimination of mycotoxins from foods is an impossible goal, it is important to ensure that their levels in food do not pose a health concern. A variety of interrelated safety approaches have been dvanced in recent years to assess the hazards, monitor and assess exposure, and determine te associated risk. Integrated mycotoxin control proframes have been developed. Risk posed by mycotoxins in food present an enormous challenge to national govermments and international agencies responsible for food safety control. food control is a widely shared responsibility that requires positive interaction between all stakeholders. Countries are allowed to adopt different food safety standards provided they ae justified by current available evidence and will not create unnecessary technical barriers to international trade. Code Ali mentarius national requirements worldwide, control through legalization is usually set no a national basis and is mainly restricted to the aflatoxins, of which aflatoxins B1 is accepted as a potent liver carcinogen. It has been recommended at the international level the tolerance level be based on a risk assessment approach rather than on analyticial limitations [i.e. level below which no detection is possible by analytical means]. National capability to cope with the impact of globalization will be crucial in the years to come. Egypt food safety control in relaton to mycotoxins is dicussed and recommendations were withdrawn