title: Assessment of exposure of Egyptian infants to aflatoxin M1 through breast milk.
abstract: BACKGROUND
  Mothers are exposed to many toxins that can reach their infants through breast milk. One of these toxins is aflatoxins, produced by Aspergillus fungus. Aspergillus colonizes grains, especially in tropical regions where there is high temperature and humidity. Aflatoxins are highly toxic, mutagenic, teratogenic, and carcinogenic. One of these is aflatoxin B1 that is excreted in breast milk as aflatoxin M1 (AFM1).
  
  
  METHODS
  This is a cross-sectional study in which 150 mother-infant dyads were included. All the infants were exclusively breastfed. Infant weights' standard deviation scores were documented at birth and at 6 months. At 6 months, before starting weaning, AFM1 was measured in breast milk by enzyme-linked immunosorbent assay and by liver enzymes; alanine aminotransferase (ALT) and aspartate aminotransferase (AST) for all mothers and infants.
  
  
  RESULTS
  Ninety-eight mothers (65.3%) had AFM1-positive breast milk samples (AFM1>0.05 μg/l according to the European Community and Codex Alimentarius). AFM1 levels ranged between 0.2 and 19.0 μg/l (mean: 7.1±5.0 μg/l). In cases considered negative, AFM1 levels ranged between 0.01and 0.05 μg/l (mean: 0.04±0.01 μg/l). Infants of AFM1-positive mothers had lower weight standard deviation scores at birth and at 6 months (P=0.04 and 0.0001). ALT and aspartate aminotransferase of mothers and ALT of infants were significantly higher in dyads having AFM1-positive breast milk (P=0.0001, 0.0001, and 0.03, respectively).
  
  
  CONCLUSIONS
  Aflatoxins represent a real threat in Egypt. The higher liver enzymes in AFM1-positive cases might represent an alarm toward future development of hepatocellular carcinoma.
  
  
  CONCLUSIONS
  Cooperation of ministries is recommended to combat this problem. The public should be educated about proper food storage and about the hazards of aflatoxin ingestion.
authors.affiliation: Paediatrics and Neonatology, Department of Paediatrics bDepartment of Clinical Pathology, Faculty of Medicine cCentre of Social and Preventive Medicine, Cairo University, Cairo, Egypt.
authors.forename: Rania H
authors.initials: RH
authors.lastname: Tomerak
authors.forename: Hala H
authors.initials: HH
authors.lastname: Shaban
authors.forename: Osama A
authors.initials: OA
authors.lastname: Khalafallah
authors.forename: Maha N
authors.initials: MN
authors.lastname: El Shazly
mesh_terms: D016604:Aflatoxin B1; D016607:Aflatoxin M1; D000818:Animals; D003430:Cross-Sectional Studies; D004534:Egypt; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005506:Food Contamination; D006801:Humans; D007492:Iran; D008892:Milk / Q000737:chemistry; D008895:Milk, Human / Q000737:chemistry
chemical_list: D016607:Aflatoxin M1; D016604:Aflatoxin B1