Risk of dietary and breastmilk exposure to mycotoxins among lactating women and infants 2-4 months in northern India

Abstract

Mycotoxins are carcinogenic secondary metabolites of fungi that have been linked to infant growth faltering. In this study, we quantified co-occurring mycotoxins in breast milk and food samples from Haryana, India, and characterized determinants of exposure. Deterministic risk assessment was conducted for mothers and infants. We examined levels of eight mycotoxins (Aflatoxin B₁ , B₂ , G₁ , G₂ , M₁ , M₂ ; Ochratoxin A, B) in 100 breast milk samples (infants 2-4 months) using ultra-high-performance liquid chromatography tandem mass spectrometry. Aflatoxin B₁ (AFB₁ ), fumonisin B₁ (FB₁ ) and deoxynivalenol (DON) were detected in several food items (n = 298) using enzyme-linked immunosorbent assays. We report novel data on the presence of mycotoxins in breast milk samples from India. Whereas breast milk concentrations (AFM₁ median: 13.7; range: 3.9-1200 ng/L) remain low, AFM₁ was detected above regulatory limits in 27% of animal milk samples. Additionally, 41% of infants were above provisional maximum tolerable daily intake (PMTDI) limits for AFM₁ due to consumption of breast milk (mean: 3.04, range: 0.26-80.7 ng kg^-1 bw day^-1 ). Maternal consumption of breads (p < 0.05) was associated with breast milk AFM₁ exposure. AFB₁ (μg/kg) was detected in dried red chilies (15.7; 0-302.3), flour (3.13; 0-214.9), groundnuts (0; 0-249.1), maize (56.0; 0-836.7), pearl millet (1.85; 0-160.2), rice (0; 0-195.6), wheat (1.9; 0-196.0) and sorghum (0; 0-63.5). FB₁ (mg/kg) was detected in maize (0; 0-61.4), pearl millet (0; 0-35.4) and sorghum (0.95; 0-33.2). DON was not detected in food samples. Mothers in our study exceeded PMTDI recommendations for AFB₁ due to consumption of rice and flour (mean: 75.81; range: 35.2-318.2 ng kg^-1 bw day^-1 ). Our findings show the presence of Aflatoxin B₁ and M₁ at various levels of the food chain and in breast milk, with estimated intakes exceeding PMTDI recommendations. Aflatoxins are known carcinogens and have also been linked to stunting in children. Their presence across the food system and in breast milk is concerning, thus warranting further research to replicate and expand on our findings and to understand implications for maternal and child health.

Keywords: aflatoxins; breast milk; cereal crops; deoxynivalenol; fumonisins; ochratoxins.

FIGURE 1

Breast milk Aflatoxin M₁ concentrations by month^a. ^aN per month, Monsoon: ‐ July: 7, Aug: 8, Sept: 9, Fall: ‐ Oct: 8, Nov: 9, Winter: ‐ Dec: 9, Jan: 8, Spring: ‐ Feb: 9, March: 8, Summer: ‐ April: 8, May: 9, June: 8

FIGURE 2

Breast milk mycotoxin concentrations by season^a,b. ^aN per month, Monsoon: ‐ July: 7, Aug: 8, Sept: 9, Fall: ‐ Oct: 8, Nov: 9, Winter: ‐ Dec: 9, Jan: 8, Spring: ‐ Feb: 9, March: 8, Summer: ‐ April: 8, May: 9, June: 8. ^bN for AFM₁: 99, after removing outlier ([AFM₁] of 1200 pg/ml