7/29/2023 0 Comments M.e.a.t. checklist hccFoods acquired at traditional markets have distinct characteristics compared to those produced on farms and consumed locally. In the context of Northern Nigeria, the breadth and magnitude of aflatoxin exposure risk associated with foods sold in traditional markets are poorly understood, particularly for the most vulnerable consumers, limiting the capacity to identify and mobilize mitigation opportunities. The risk of dietary aflatoxin exposure is particularly pronounced in many sub-Saharan African food systems, where obsolete monitoring infrastructure, poverty, and weak beaurocratic structures coincide with high reliance on aflatoxin-susceptible staples, such as maize and groundnuts. In addition to its carcinogenic properties, aflatoxin is associated with growth impairment in children ( Khlangwiset et al., 2011) and may be an important driver of environmental enteropathy, resulting in compromised gut integrity and limited nutrient adsorption ( Smith et al., 2012), although evidence for contribution to stunting is less strong ( Hoffmann et al., 2018). Aflatoxin is a potent carcinogen, implicated in hepatocellular carcinoma (HCC) in humans, and, in some contexts, a leading risk factor for HCC ( Liu and Wu, 2010). One such contaminant, aflatoxin, is widespread in informal grain value chains in LMICs and constitutes a food safety concern of burgeoning importance both for public health and economic prosperity in traditional market settings. However, most of the poor obtain food from traditional markets so these are of especial interest ( Grace, 2015). Food safety regulatory systems in many LMIC markets, formal and informal, are often insufficient for preventing exposures to contaminants that can jeopardize community health and offset the nutritive value of food. Traditional food markets-also known as informal markets and comprising “wet” or public markets, small shops, vendors and other non-modern retail-are critical for ensuring access to safe, nutritious diets in many low- and middle-income countries (LMIC) ( Wertheim-Heck et al., 2019). These findings constitute a novel multi-study risk assessment approach in the Nigerian context and substantiate existing evidence suggesting that there is reason for public health concern regarding aflatoxin exposure in the Nigerian population. Sensitivity analysis revealed that aflatoxin concentration, dietary consumption levels, consumption frequency, and other variables have differing relative contributions to HCC risk across commodities. The quantitative risk assessment estimated that 1.77, 0.44, 0.43, 0.15, and 0.01 HCC cases per year/100,000 population were attributable to aflatoxin exposure through maize, groundnut, rice, cowpea, and soybean, respectively. EDIs for maize, groundnut, rice, and cowpea exceeded the provisional maximum tolerable daily intake (PMTDI) level of 1 kgbw-1 day-1, with maize yielding the highest mean EDI (36.7 kgbw-1 day-1). In total, 41 eligible studies reporting aflatoxin contamination were used to model the distribution of aflatoxin concentrations in Nigerian commodities. Estimated dietary intake (EDI) was computed using publicly available dietary consumption data and a probabilistic quantitative risk assessment was conducted to determine the relative risk of HCC associated with consumption of selected aflatoxin-contaminated commodities. This study identifies levels of HCC risk in the northern Nigerian adult population, leveraging a systematic review of available evidence on aflatoxin contamination in Nigerian maize, groundnut, rice, cowpea, and soybean. Low-resource food environments in sub-Saharan Africa are often under-regulated and are particularly vulnerable to adverse health and nutrition outcomes associated with aflatoxin exposure.
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