Aflatoxin: A Synthesis of the Research in Health, Agriculture and Trade

“Globally it is
estimated that
aflatoxin contributes
to between 4.6 and
28.2 percent of liver
cancer cases.”
“...aflatoxin
impairs growth and
contributes to immune
suppression...”
lack of reliable data is a key challenge to quantifying the magnitude of
the economic and health consequences associated with the consumption
of aflatoxin-contaminated food in developing countries. it is difficult to fully
attribute the impact of aflatoxin-contamination on liver disease in developing
countries, as liver disease can be masked by acute aflatoxicosis and can be
misdiagnosed. 32
there are three primary interventions to mitigate the effects of aflatoxicosis
on human liver disease: clinical, dietary, and agricultural. one effective
clinical intervention is administering the hepatitis B vaccination, particularly to
children. 33 complete elimination of aflatoxin is unlikely, and as a result, only
proper management can mitigate the health effects globally. 34
B.3 liver cirrHoSiS
the link between aflatoxin and liver cirrhosis is not as well documented as that
with liver cancer. Some studies have suggested that the link between aflatoxin
and liver cirrhosis is weak, 35 whereas other studies have indicated that there
is sufficient evidence to associate aflatoxin with cirrhosis. A study on aflatoxin
exposure and the cause of liver cirrhosis in the Gambia found that chronic
hepatitis B infection and aflatoxin exposure—either separately or in synergy—
were the agents most likely responsible for most cirrhosis cases in that West
African population. 36
B.4 iMMune SySteM And linkS witH StuntinG
Research shows that aflatoxin impairs growth and contributes to immune
suppression in animals; however, immune suppression in humans has only
recently been seriously investigated, mostly in children. A study in Benin and
togo found that stunted and/or underweight children had an average of 30 to
40 percent higher levels of aflatoxin-albumen levels in the blood than children
with a normal body weight. 37 A study carried out in the Gambia by turner
et al. demonstrated that elevated aflatoxin-albumin levels were associated
with stunting and underweight among children ages 6 to 9 years, the oldest
cohort yet to show that linkage. children in developing countries appear to be
naturally exposed to aflatoxin through their diet at levels that compromise the
immune system in other species. immune functions associated with increased
susceptibility to bacterial and parasitic infections have also been attributed to
aflatoxin exposure. 38
in general, the proportion of childhood growth stunting is directly correlated
with the proportion of the population living below the national poverty line, and
is inversely correlated with gross domestic product per capita. 39 As is the case
with liver cancer, childhood stunting is prominent in regions such as Southeast
Asia and Sub-Saharan Africa, where aflatoxin exposure through consuming
contaminated food is common. figure 7 describes the correlation between
socioeconomic characteristics, aflatoxin exposure, and the prevalence of
stunting in 12 countries.
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