Table 5.
Summary of studies on relationships between mycotoxin exposure and child growth in sub-Saharan Africa.
| Country | Population Size/Group | Matrix/Study Design | Toxin Type | Concentration Range (Rate) | % Rate of Malnutrition | Result | Reference |
|---|---|---|---|---|---|---|---|
| Benin and Togo |
480 Children Age: 9 months–5 years |
AF-albumin (blood)/cross-sectional | AFs | 5–1064 pg/mg (99%) |
HAZ: 33% WAZ: 29% WHZ: 6% |
AF-albumin concentration negatively correlated with the growth parameters (HAZ (p = 0.001), WAZ (p = 0.005), and WHZ (p = 0.047)). | [33] |
| Benin | 200 Children Age: 16–37 months |
AF-albumin (blood)/longitudinal (8 months) at three points: February, June, and October | AFs | February: 37.4 pg/mg (98%) June: 38.7 pg/mg (99.5%) October: 86.8 pg/mg (100%) |
Not calculated | AF-albumin level measured at recruitment or the mean of three time points was inversely associated with HAZ and WHZ scores measured at the last time point. Strong negative correlation (p < 0.0001) between AF-albumin and height increase over the 8 months follow-up after adjustment for age, sex, height at recruitment, socioeconomic status, village, and weaning status. Highest quartile of AF-albumin was associated with a mean 1.7 cm reduction in growth over 8 months compared with the lowest quartile. |
[34] |
| Cameroon | 220 Children Age: 1.5–4.5 years |
Urine/cross-sectional | OTA DON AFM1 FB1 ZEN β-ZEL α-ZEL |
73% of the samples were contaminated with mycotoxin | HAZ: 39% WAZ: 37% WHZ: 23% |
Significant differences were observed between the weaning categories and AFM1 concentration detected in the urine. No association between the different malnutrition categories (stunted, wasting, and underweight) and the mycotoxin concentrations detected in the urine samples. |
[130] |
| Ethiopia | 200 Children Age: 1–4 years |
Urine/cross-sectional | AFs | Values in ng/mL: AFM1: 0.06–0.07 AFB2: <LOQ–0.06 AFG1: 0.05–0.065 AFG2: 0.066-0.07 AF (17%) |
HAZ: 45% WAZ: 17% WHZ: 1% |
No association between the different malnutrition categories (stunted, wasting, and underweight) and AF exposure. | [131] |
| Gambia | 138 Children Age: 0–12 months |
AF-albumin (blood)/longitudinal (14 months follow-up from birth until one year of age) | AFs | Maternal blood: 4.8–260.8 pg/mg (100%) Cord blood: 5.0–189.6 pg/mg (48.5%) |
Not calculated | High maternal AF-albumin was associated to lower HAZ (p = 0.044) and WAZ (p = 0.012) scores. Reduction of maternal AF-albumin from 110 pg/mg to 10 pg/mg would lead to an increase of 0.8 kg in weight and 2 cm increase in height of a child within the first year of life. |
[36] |
| Infant blood: 5.0–30.2 pg/mg (11%) | AF-albumin measured at Week 16 was negatively related to HAZ (p = 0.002). | ||||||
| 374 Infants Age: 0–2 years |
AF-albumin (blood)/longitudinal | AFs | 48, 98, and 99% had detectable AF-albumin concentrations (LOD > 3.0 pg/mg at 6, 12, 18 months, respectively) | HAZ: 25.9% WAZ: 24.4% WHZ: 12.9% |
Inverse relationships between AF-albumin adducts and HAZ, WAZ, and WHZ scores from the age of 6 to 18 months. Inverse relationship between AF-albumin at 6 months and change in WHZ between 6 and 12 months (p = 0·013). AF-albumin at 12 months was associated with changes in HAZ and infant length between the age of 12 and 18 months. AF-albumin at 6 months was associated with IGFBP-3 at 12 months (p = 0·043). |
[141] | |
| Kenya | 242 Children Age: 3–36 months |
Weaning flour/cross-sectional | AFs | 2–82 µg/kg (29%) | HAZ: 34% WAZ: 30% WHZ: 6% |
Highly significant association between children that consumed AF-contaminated flour and prevalence of wasting (p = 0.002). | [37] |
| 204 Children Age: 1–3 years |
Cereals (maize, sorghum) and milk/cross-sectional | AFs AFM1 |
AF: 0–194 µg/kg in cereals AFM1: 0.002–2.56 µg/kg in milk (98%) |
HAZ: 41% WAZ: 17% WHZ: 4% |
AFM1 was negatively associated with HAZ (p = 0.047). No association between total AFs (AFB and AFG) and HAZ, WAZ, and WHZ Scores. |
[44] | |
| Kenya | 881 Children Age: 0–2 years |
AFB1-lysine adduct/cluster randomised longitudinal |
AFs | *18.1 pg/mg albumin | Not calculated | The intervention significantly reduced endline serum AFB1-lysine adduct levels (p = 0.025). No effect on the prevalence of stunting or LAZ, though a significant effect on child linear growth was found at midline (11–19 months). |
[142] |
| Nigeria | 58 Children Age: 6–48 months (with severe acute malnutrition) |
AFB1-lysine/cross-sectional | AFs | 0.2–59.2 pg/mg albumin |
Severe acute malnutrition: 81% HAZ: 74% |
Significantly higher AFB1-lysine concentrations in stunted children compared to non-stunted children as well as in children with severe acute malnutrition compared to controls. No significant association between AFB1-lysine and stunting after adjustment for malnutrition status (OR = quartile 3, 1.21; 95% CI: 0.086–31.45) and no correlation between AFB1-lysine and WAZ. |
[143] |
| Tanzania | 215 Infants Age: 6 months |
Maize/longitudinal (follow-up at 6 and 12 months of age) | FBs | 21–3201 µg/kg (69% of 191 maize samples) |
Not calculated | Infants exposed to FBs above the PMTDI (2 µg/kg) were significantly shorter by 1.3 cm and lighter by 328 g at 12 months (p = 0.002). | [38] |
| 143 Infants Age: 0–6 months 143 Lactating mothers |
Breast milk/longitudinal (follow-up at three points: 1st, 3rd, and 5th months of age) | AFM1 | 1st month: 0.01–0.55 ng/mL 3rd month: 0.01–0.47 ng/mL 5th month: 0.01–0.34 ng/mL |
1st month: HAZ: 11% WAZ: 4% WHZ: 4% 3rd month: HAZ: 13% WAZ: 9% WHZ: 1% 5th month HAZ: 17% WAZ: 10% WHZ: 3% |
Significant inverse association between AFM1 exposure levels and WAZ or HAZ (p < 0.05). | [100] | |
| Tanzania | 166 Children Age: 6–14 months old |
AF-albumin and UFB1/ longitudinal (12 month follow-up) |
AFs FBs |
AF-albumin: at recruitment: *4.7 pg/mg (67%), 6 months: *12.9 pg/mg (84%), 12 months: *23.5 pg/mg (99%) UFB1: at recruitment: *313.9 pg/mg (98%), 6 months: *167.3 pg/mg (96%), 12 months: *569.5 pg/mg (100%) |
At recruitment HAZ: 44% WAZ: 8% WHZ: 2% At 6 months: HAZ: 55% WAZ: 14% WHZ: 2% At 12 months: HAZ: 56% WAZ: 14% WHZ: 0.7% |
No significant negative association between mean AF-albumin levels and child growth (HAZ, WHZ, or WAZ score). Negative association between mean UFB1 concentrations (at recruitment, and 6 and 12 months from recruitment) and HAZ at recruitment. |
[128] |
| 143 Infants Age: under 6 months |
Maize flour/longitudinal (follow-up at three points: 1st, 3rd, and 5th months of age) | AFs FBs |
AF: 0.33–69.5 µg/kg (58% of 67 maize samples) FB: 48–1224 µg/kg (31% of 67 maize samples) |
WAZ: 35% of 115 infants HAZ: 43% of 115 infants |
Insignificant association was observed between exposure to AFs or FBs and stunting or underweight. | [76] | |
| 300 Children |
Maize/cluster randomised controlled trial |
AFs FBs |
Not reported | Not calculated | AF and FB intakes were inversely associated with WAZ. WAZ was 6.7% lower in the intervention group. Mean WAZ difference between the groups was 0.57 (p = 0.007). | [144] | |
| Tanzania | 114 Children Age: under 36 months |
AFB1- lysine and UFB1/ longitudinal |
AFs FBs |
AFB1-lysine: 0.28–25.1 pg/mg (72%) UFB1:<LOD–16.6 ng/mL (80%) |
At 24 months: HAZ: 61% WAZ: 17% WHZ: 3% At 36 months: HAZ: 75% WAZ: 21% WHZ: 0% |
No associations were found between AF exposure and growth impairment as measured by stunting, underweight, or wasting. However, FB exposure was negatively associated with underweight. |
[41] |
| Uganda | 246 Dyads |
Maternal serum/longitudinal (follow-up: pregnancy up to one year) |
AFs | AFB1: *113.9 pg/mg | Not calculated | A negative effect of AF exposure on infant linear growth (HAZ) in HIV-positive pregnant women and their infants. Infants of HIV-positive women were in high perinatal AF category with lower HAZ scores (0.460) when compared with the infants of HIV-negative low-AF exposed women (p = 0.006). |
[145] |
| 220 infants Age: 0–48 h |
Maternal serum/cross-sectional | AFs | AFB1: 0.71–95.6 pg/mg albumin | Not calculated | Maternal AFB-lysine levels were significantly associated with lower birth weight (adj-β: p = 0.040), lower WAZ (adj-β: p = 0.037), smaller HC (adj-β: p = 0.035), and lower HCZ (adj-β: p = 0.023) at birth. No significant associations were observed between maternal AFB-lysine levels and infant length, WHZ, HAZ, or gestational age at birth. | [146] |
* Mean concentrations, AFs = total aflatoxins; AFB1, M1 = aflatoxin B1, M1; FBs = total fumonisin B; FB1 = fumonisin B1; IGFBP-3 = insulin-like growth factor-1 binding protein-3; DON = deoxynivalenol; ZEN = zearalenone; α-ZEL = α-zearalenol; β-ZEL = β-zearalenol; LOD = limit of detection; LOQ = limit of quantification; OTA = ochratoxin A; UFB1 = urinary fumonisin B1; ZEN = zearalenone; adj-β = adjusted model; HAZ = height-for-age Z-score; HC = head circumference; HCZ = head circumference-for-age Z-score; WAZ = weight-for-age Z-score; WHZ = weight-for-height Z-score.