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. 2018 Dec 1;3(6):e000983.
doi: 10.1136/bmjgh-2018-000983. eCollection 2018.

The impact of reducing dietary aflatoxin exposure on child linear growth: a cluster randomised controlled trial in Kenya

Vivian Hoffmann  1 , Kelly Jones  2 , Jef L Leroy  3
Affiliations

The impact of reducing dietary aflatoxin exposure on child linear growth: a cluster randomised controlled trial in Kenya

Vivian Hoffmann et al. BMJ Glob Health. .

Erratum in

Abstract

Introduction: Observational studies have documented an association between aflatoxin (AF) exposure and reduced linear growth in infants and young children. Our objective was to assess the effectiveness of reducing AF exposure on child linear growth and serum AF levels in rural areas in Eastern Kenya.

Methods: A cluster randomised controlled design was used (28 intervention and 28 control clusters). The intervention arm received a swapping (contaminated maize was replaced with safe maize) and a stockist intervention (households were encouraged to purchase from a stockist supplied with clean maize). Women in the fifth to final month of pregnancy were invited to enrol in the study. Outcomes were child length-for-age Z-score (LAZ), the prevalence of stunting and child serum AFB1-lysine adduct level 24 (endline, primary outcomes) and 11 to 19 months (midline, secondary outcomes) after trial commencement, respectively. The trial was registered with socialscienceregistry.org.

Results: Of the 1230 unborn children enrolled in the study, 881 (72%) were included in the LAZ and 798 (65%) in the serum AFB1 analysis. The intervention significantly reduced endline ln serum AFB1-lysine adduct levels (intervention effect-0.273, 95% CI -0.547 to 0.001; one-sided p=0.025), but had no effect on endline LAZ or stunting (mean LAZ at endline was -1.64). At midline, the intervention increased LAZ by 0.16 (95% CI -0.009 to 0.33; one-sided p=0.032) and reduced stunting by seven percentage points (95% CI -0.125 to -0.007; one-sided p=0.015), but had no impact on serum AFB1 levels.

Conclusion: Improving access to AF-free maize substantially reduced endline serum AF, but had no effect on child linear growth. The midline analysis suggests that AF may affect linear growth at younger ages.

Trial registration number: AEARCTR-0000105.

Keywords: Kenya; aflatoxin; child linear growth; exposure; serum aflatoxin level.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Study timeline.
Figure 2
Figure 2
Trial profile. AFB, Alfatoxin B1; LAZ, length-for-age Z-score.
See this image and copyright information in PMC

References

    1. Pitt JI, Wild CP, Baan RA. Improving public health through mycotoxin control. Lyon: International Agency for Research on Cancer, 2012.
    1. Basappa SC. Aflatoxins: formation, analysis and control. Alpha Science International: Oxford:, 2009.
    1. Marasas WFO, Gelderblom WCA, Shephard GS. Mycotoxins: a global problem : Leslie JF, Bandyopadhyay R, Visconti A, Mycotoxins: detection methods, management. Public Health and Agricultural Trade, 2008: 29–39.
    1. Smith LE, Stoltzfus RJ, Prendergast A. Food chain mycotoxin exposure, gut health, and impaired growth: a conceptual framework. Adv Nutr 2012;3:526–31. 10.3945/an.112.002188 - DOI - PMC - PubMed
    1. Shuaib FM, Jolly PE, Ehiri JE, et al. Association between birth outcomes and aflatoxin B1 biomarker blood levels in pregnant women in Kumasi, Ghana. Trop Med Int Health 2010;15:160–7. 10.1111/j.1365-3156.2009.02435.x - DOI - PubMed

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