Mycotoxin exposure of infants through the breastmilk of mothers in western Kenya and associations with maternal and child nutrition. 公开

Abstract

     Malnutrition undermines a child’s growth and development with significant lifelong consequences. With 26% of children stunted in Kenya, malnutrition represents a significant public health burden.¹ Recent research implicates environmental enteropathy (EE), a sub-clinical inflammatory condition of the intestinal lining that limits nutrient absorption, in the etiology of stunting. To date, the majority of research on the causes of EE and subsequent malnutrition has focused on the role of infectious pathogens and parasites. However, increasing attention is turning to mycotoxins. Mycotoxins are carcinogenic toxins released by fungi that infect common staple and legume crops. This study quantifies infant exposure to mycotoxins (aflatoxin M1, fumonisin B1, ochratoxin A, and deoxynivalenol) through breastmilk and explores the role of mycotoxins, specifically aflatoxin M1, in the etiology of child malnutrition and maternal mastitis and anemia in western Kenya.  Anthropometry, breastmilk and capillary blood samples were collected at 4- and 9-months postpartum from a cohort of 505 women recruited from 8 health facilities in two counties in western Kenya. Breastmilk samples were processed and analyzed for mycotoxins using liquid-chromatography high resolution mass spectrometry. Subclinical mastitis was evaluated using ion selective electrodes for sodium:potassium contents. Hemoglobin from capillary samples were quantified using the HemoCue Hb 201+. All four mycotoxins were found to be present in 34-90% of the breastmilk samples depending on the mycotoxin and visit. There were no statistically significant associations between sampling season or facility. Aflatoxin M1 was the only mycotoxin to have levels above the European Union (EU) cutoffs for infant milk replacement formula (0.025 ng/mL). At the 4^th and 9^th month visit 73.85% and 75.82% of samples, respectively were above the EU cutoffs. Further, 47.93% of samples were elevated at both visits and only 5.44% were below cutoffs at both visits. Regression modeling revealed no statistically significant relationship between elevated aflatoxin levels and child stunting, wasting, underweight, or anemia at 4 or 9 months. There were also no statistically significant associations detected between breastmilk aflatoxin levels and maternal mastitis or anemia. There were statistically significant associations found between chronic aflatoxin exposure and infant WAZ and WHZ, and maternal subclinical mastitis at the 4-month follow-up. This study found widespread Aflatoxin M1 contamination of breastmilk in western Kenya. There were no significant associations between aflatoxin levels and indicators of maternal or infant nutrition; however, longer term exposure and follow up may be necessary to detect impacts on child growth. Given the known negative impacts of mycotoxins on health, mycotoxin control policies and programs are urgently needed in western Kenya that reduce mycotoxin contamination of the food supply.

 

 

 

 

 

 

 

 

1.  Statistics, K. N. B. of, Health/Kenya, M. of, Council/Kenya, N. A. C., Institute, K. M. R., & Development/Kenya, N. C. for P. and. (2015). Kenya Demographic and Health Survey 2014. Retrieved from http://dhsprogram.com/publications/publication-FR308-DHS-Final-Reports.cfm

 

Table of Contents

TABLE OF CONTENTS

 

ABSTRACT...................................................................................................................... iv

 

ACKNOWLEDGEMENTS.................................................................................................... vii

 

TABLE OF CONTENTS..................................................................................................... viii

 

1. INTRODUCTION........................................................................................................ 1

 

A. Introduction and Rationale...................................................................................... 1

 

B. Problem Statement................................................................................................. 2

 

C. Purpose Statement................................................................................................. 3

 

D. Research Questions................................................................................................ 3

 

E. Significance Statement............................................................................................ 4

 

F. Definition of Terms................................................................................................. 4

 

2. LITERATURE REVIEW................................................................................................. 5

 

2.1  Introduction........................................................................................................ 5

 

2.1.1  Stunting.................................................................................................... 6

 

2.1.2  Wasting..................................................................................................... 7

 

2.1.3  Underweight............................................................................................... 7

 

2.1.4  First 1,000 Days and Maternal Nutrition..........................................................8

 

2.1.5  Environmental Enteropathy...........................................................................9

 

2.2  What are Mycotoxins...........................................................................................10

 

2.2.1  Aflatoxins..................................................................................................12

 

Figure 1.......................................................................................................13

 

Figure 2...................................................................................................... 14

 

2.2.2  Fumonisins............................................................................................... 15

 

Figure 3...................................................................................................... 17

 

2.2.3  Ochratoxin A............................................................................................ 17

 

Figure 4...................................................................................................... 18

 

2.2.4  Deoxynivalenol......................................................................................... 19

Figure 5...................................................................................................... 20

 

2.3  Agriculture........................................................................................................ 20

 

2.4  Maternal and Child Health................................................................................... 22

 

2.5  Public Health Problem......................................................................................... 24

 

Figure 6...................................................................................................... 27

 

3. MANUSCRIPT........................................................................................................... 28

 

MANUSCRIPT TITLE.................................................................................................. 29

 

ABSTRACT............................................................................................................... 30

 

INTRODUCTION....................................................................................................... 32

 

METHODS............................................................................................................... 38

 

Data Collection................................................................................................... 38

 

Sample Storage................................................................................................. 39

 

Breastmilk Analysis............................................................................................. 39

 

Variable Specification.......................................................................................... 40

 

Statistical Analysis.............................................................................................. 40

 

RESULTS................................................................................................................. 41

 

DISCUSSION........................................................................................................... 42

 

CONCLUSION........................................................................................................... 47

 

TABLES................................................................................................................... 52

 

Table 1............................................................................................................. 52

 

Table 2............................................................................................................. 54

 

Table 3............................................................................................................. 55

 

Table 4............................................................................................................. 56

 

4. IMPLICATIONS........................................................................................................ 57

 

REFERENCES:................................................................................................................ 60

 

SUPPLEMENTAL MATERIAL:............................................................................................. 65

 

Supplemental Table 1......................................................................................... 65

 

Supplemental Table 2......................................................................................... 67

 

Supplemental Table 3......................................................................................... 67

 

Supplemental Figure 1........................................................................................ 68

 

.Supplemental Figure 2....................................................................................... 68

 

Supplemental Figure 3........................................................................................ 69

 

Supplemental Figure 4........................................................................................ 69

 

Supplemental Figure 5........................................................................................ 70

 

Supplemental Figure 6........................................................................................ 70

 

Supplemental Figure 7........................................................................................ 71

 

Supplemental Figure 8........................................................................................ 71

 

 

 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Nutrition
关键词	breastmilk aflatoxin first 1,000 days ochratoxin underweight maternal and child health mastitis deoxynivalenol anemia stunting environmental enteropathy wasting mycotoxin fumonisin nutrition malnutrition
Committee Chair / Thesis Advisor	Webb-Girard, Amy, Emory University
Committee Members	Barr, Dana Boyd, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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