presence of aflatoxins in smoked-dried fish sold in abeokuta, ogun ...

2.13 Outstanding Health Questions in Aflatoxin Management
Increased liver cancer incidence associated with aflatoxins occurs in areas of the world with
chronic high levels of toxins, frequently exceeding the regulatory levels under consideration by
the Codex Alimentarius Commission (2001) by large amounts, sometimes factors of 10 or 100,
and endemic infection with hepatitis B or C viruses (HBV or HCV). Some basis exists for
quantifying the effects of aflatoxin exposure on liver cancer risk, and for the greater impact of
aflatoxins in areas of high HBV or HCV incidence (JECFA, 2001). However, uncertainty
remains regarding the health effects of occasional high exposures occurring due to unusual
weather patterns, in comparison with those due to normal chronic exposure; the effect of
combinations of mycotoxins, e.g. aflatoxins and fumonisins, on cancer risk; and the broader
health effects of aflatoxin exposure. Under the latter consideration, the most important aspects
are the greater sensitivity of children to acute toxicity of aflatoxins as compared with adults; the
in-utero effects of aflatoxins, known to cross the placenta; the immunosuppressive effects of
aflatoxins, which may influence susceptibility to infectious disease; the suppressive effects of
aflatoxins on growth; and the interactions between HCV, HBV and aflatoxins in liver cancer
development in various populations in the world.
The areas mentioned are important ones for future research, to provide information of direct
relevance to public health decisions regarding aflatoxin exposure.
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