Aflatoxins are natural food crop pollutants that are involved in the pathogenesis of different human diseases. Aflatoxins are natural pollutants in food crops, including milk, meat, and dried fruit, such as cereals, oilseeds, spices, and tree nuts. Various deleterious health effects, such as hepatotoxicity, liver cancer, miscarriage, malnutrition, growth retardation and immunosuppression, have been associated with acute and chronic exposure to aflatoxins. Nearly 30% of children under 5 years of age in Nigeria are malnourished[12], but research indicating a potential role for aflatoxin in PEM were focused solely on the discovery of high aflatoxin concentrations in autopsy lung, kidney and liver specimens of children who died of kwashiorkor. The goal of this study was to determine the associations between aflatoxins and protein-energy malnutrition (PEM) in Nigerian children with PEM by measuring aflatoxins in serum, urine and food. A cross-sectional study of 79 children with PEM (kwashiorkor n=36, marasmic kwashiorkor n=29 and marasmus n=13) and 33 healthy controls, matched by age and sex, was conducted in 3 agro-ecological regions of Nigeria (Guinea savannah, Sudan savannah and Rainforest) where aflatoxins B1, B2, G1, G2, M1 and M2 were measured in serum, urine and platelet food. The detection rates of aflatoxin among healthy controls were higher in the Guinea Savannah (72.2 percent) than in the Sudan Savannah (53.8 percent), although statistically insignificant. In comparison to dietary classes, aflatoxin identification concentrations were higher in patients with marasmic kwashiorkor (93.1%) and kwashiorkor (88.9%), compared with marasmus (76.9%) and controls (63.6%, p=0.013). The B1 aflatoxin detection rates followed a similar pattern, i.e. Marasmic Kwashiorkor (82.4%), Kwashiorkor (69.4%), Marasmus (53.8%), and controls (42.4%, p=0.007). M2 had the highest detection rates in all patient groups and controls of all forms of aflatoxins detected in serum. The median concentrations of aflatoxins detected in serum in each PEM group were significantly higher than in the control group, but there were no statistically meaningful comparisons between the PEM groups. The frequency and concentrations of aflatoxins found in urine and food were not statistically different in the PEM and control groups. However as opposed to PEM patients, the controls had the lowest serum/urine aflatoxin ratio as well as the lowest median aflatoxin concentrations in their food. In conclusion, aflatoxins are commonly found in Nigerian children’s body fluids and food, but more often and at higher concentrations in PEM children, likely due to reduced excretion or increased exposure. If aflatoxins contribute to the pathogenesis of all forms of PEM and not necessarily kwashiorkor alone, future prospective studies are desirable to evaluate.

Author(s) Details

Prof. G. C. Onyemelukwe
Immunology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria.

D. Ogoina
Immunology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria.

G. E. Ibiam
Department of Boichemistry, Ahmadu Bello University, Zaria.

G. H. Ogbadu
Department of Boichemistry, Ahmadu Bello University, Zaria.

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