title: Aflatoxin exposure may contribute to chronic hepatomegaly in Kenyan school children.
abstract: BACKGROUND
  Presentation with a firm type of chronic hepatomegaly of multifactorial etiology is common among school-age children in sub-Saharan Africa.
  
  
  OBJECTIVE
  Aflatoxin is a liver toxin and carcinogen contaminating staple maize food. In this study we examined its role in chronic hepatomegaly.
  
  
  METHODS
  Plasma samples collected in 2002 and again in 2004 from 218 children attending two schools in neighboring villages were assayed for aflatoxin exposure using the aflatoxin-albumin adduct (AF-alb) biomarker. Data were previously examined for associations among hepatomegaly, malaria, and schistosomiasis.
  
  
  RESULTS
  AF-alb levels were high in children from both schools, but the geometric mean (95% confidence interval) in year 2002 was significantly higher in Matangini [206.5 (175.5, 243.0) pg/mg albumin] than in Yumbuni [73.2 (61.6, 87.0) pg/mg; p < 0.001]. AF-alb levels also were higher in children with firm hepatomegaly [176.6 (129.6, 240.7) pg/mg] than in normal children [79.9 (49.6, 128.7) pg/mg; p = 0.029]. After adjusting for Schistosoma mansoni and Plasmodium infection, we estimated a significant 43% increase in the prevalence of hepatomegaly/hepatosplenomegaly for every natural-log-unit increase in AF-alb. In 2004, AF-alb levels were markedly higher than in 2002 [539.7 (463.3, 628.7) vs. 114.5 (99.7, 131.4) pg/mg; p < 0.001] but with no significant difference between the villages or between hepatomegaly and normal groups [539.7 (436.7, 666.9) vs. 512.6 (297.3, 883.8) pg/mg], possibly because acute exposures during an aflatoxicosis outbreak in 2004 may have masked any potential underlying relationship.
  
  
  CONCLUSIONS
  Exposure to aflatoxin was associated with childhood chronic hepatomegaly in 2002. These preliminary data suggest an additional health risk that may be related to aflatoxin exposure in children, a hypothesis that merits further testing.
authors.affiliation: Division of Epidemiology, Leeds Institute for Genetics, Health and Therapeutics, University of Leeds, Leeds, United Kingdom. medyg@leeds.ac.uk
authors.forename: Yun Yun
authors.initials: YY
authors.lastname: Gong
authors.forename: Shona
authors.initials: S
authors.lastname: Wilson
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Mwatha
authors.forename: Michael N
authors.initials: MN
authors.lastname: Routledge
authors.forename: Jovita M
authors.initials: JM
authors.lastname: Castelino
authors.forename: Bin
authors.initials: B
authors.lastname: Zhao
authors.forename: Gachuhi
authors.initials: G
authors.lastname: Kimani
authors.forename: H Curtis
authors.initials: HC
authors.lastname: Kariuki
authors.forename: Birgitte J
authors.initials: BJ
authors.lastname: Vennervald
authors.forename: David W
authors.initials: DW
authors.lastname: Dunne
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Wild
mesh_terms: D000348:Aflatoxins / Q000097:blood / Q000633:toxicity*; D000704:Analysis of Variance; D002648:Child; D018736:DNA Adducts / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D005506:Food Contamination; D006529:Hepatomegaly / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D016015:Logistic Models; D015995:Prevalence; D003313:Zea mays / Q000737:chemistry*
chemical_list: D000348:Aflatoxins; D018736:DNA Adducts