title: Aflatoxin exposure during the first 36 months of life was not associated with impaired growth in Nepalese children: An extension of the MAL-ED study.
abstract: Exposure to aflatoxin, a mycotoxin common in many foods, has been associated with child growth impairment in sub-Saharan Africa. To improve our understanding of growth impairment in relation to aflatoxin and other risk factors, we assessed biospecimens collected in Nepalese children at 15, 24, and 36 months of age for aflatoxin exposure. Children (N = 85) enrolled in the Bhaktapur, Nepal MAL-ED study encompassed the cohort analysed in this study. Exposure was assessed through a plasma biomarker of aflatoxin exposure: the AFB1-lysine adduct. The aflatoxin exposures in the study participants were compared to anthropometrics at each time period (length-for-age [LAZ], weight-for-age [WAZ], and weight-for-length [WLZ] z-scores), growth trajectories over time, age, and breastfeeding status. Results demonstrated chronic aflatoxin exposure in this cohort of children, with a geometric mean of 3.62 pg AFB1-lysine/mg albumin. However, the chronic aflatoxin exposure in this cohort was not significantly associated with anthropometric z-scores, growth trajectories, age, or feeding status, based on the available time points to assess aflatoxin exposure. Low mean levels of aflatoxin exposure and infrequent occurrence of stunting, wasting, or underweight z-score values in this cohort are possible contributing factors to a lack of evidence for an association. Further research is needed to examine whether a threshold dose of aflatoxin exists that could induce child growth impairment.
authors.affiliation: Department of Food Science and Human Nutrition, Michigan State University, East Lansing, Michigan, United States of America.
authors.forename: Nicole J
authors.identifier: http://orcid.org/0000-0002-3456-6913
authors.initials: NJ
authors.lastname: Mitchell
authors.affiliation: Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Hui-Husan
authors.initials: HH
authors.lastname: Hsu
authors.affiliation: Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Bergen, Norway.|Department of Child Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
authors.forename: Ram Krishna
authors.initials: RK
authors.lastname: Chandyo
authors.affiliation: Walter Reed/Armed Forces Research Institute of Medical Sciences, Research Unit, Kathmandu, Nepal.
authors.forename: Binob
authors.initials: B
authors.lastname: Shrestha
authors.affiliation: Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.
authors.forename: Ladaporn
authors.initials: L
authors.lastname: Bodhidatta
authors.affiliation: Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Yu-Kang
authors.initials: YK
authors.lastname: Tu
authors.affiliation: Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast, United Kingdom.
authors.forename: Yun-Yun
authors.initials: YY
authors.lastname: Gong
authors.affiliation: Department of Environmental Health Sciences, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Egner
authors.affiliation: Department of Child Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
authors.forename: Manjeswori
authors.initials: M
authors.lastname: Ulak
authors.affiliation: Department of Environmental Health Sciences, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: John D
authors.initials: JD
authors.lastname: Groopman
authors.affiliation: Department of Food Science and Human Nutrition, Michigan State University, East Lansing, Michigan, United States of America.
authors.forename: Felicia
authors.initials: F
authors.lastname: Wu
mesh_terms: D000348:Aflatoxins / Q000633:toxicity*; D001942:Breast Feeding; D002675:Child, Preschool; D004781:Environmental Exposure / Q000009:adverse effects*; D005243:Feces / Q000737:chemistry; D006130:Growth Disorders / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018977:Micronutrients / Q000032:analysis; D009390:Nepal / Q000453:epidemiology; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000348:Aflatoxins; D018977:Micronutrients