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Human aflatoxicosis in developing countries: a review of toxicology, exposure, potential health consequences, and interventions^1,2,3

¹ From the Peanut Collaborative Research Program, Griffin, GA (JHW and DA); the College of Veterinary Medicine, Texas A & M University, College Station, TX (TDP); the School of Public Health, The University of Alabama at Birmingham (PEJ); the Department of Microbiology/Immunology, Morehouse School of Medicine, Atlanta (JKS); and the Department of Agricultural Economics, Auburn University, Auburn, AL(CMJ)

Aflatoxins are well recognized as a cause of liver cancer, but they have additional important toxic effects. In farm and laboratory animals, chronic exposure to aflatoxins compromises immunity and interferes with protein metabolism and multiple micronutrients that are critical to health. These effects have not been widely studied in humans, but the available information indicates that at least some of the effects observed in animals also occur in humans. The prevalence and level of human exposure to aflatoxins on a global scale have been reviewed, and the resulting conclusion was that 4.5 billion persons living in developing countries are chronically exposed to largely uncontrolled amounts of the toxin. A limited amount of information shows that, at least in those locations where it has been studied, the existing aflatoxin exposure results in changes in nutrition and immunity. The aflatoxin exposure and the toxic affects of aflatoxins on immunity and nutrition combine to negatively affect health factors (including HIV infection) that account for >40% of the burden of disease in developing countries where a short lifespan is prevalent. Food systems and economics render developed-country approaches to the management of aflatoxins impractical in developing-country settings, but the strategy of using food additives to protect farm animals from the toxin may also provide effective and economical new approaches to protecting human populations.

Key Words: Aflatoxin • chronic exposure • health risks • infectious diseases • iron • zinc • selenium • vitamin • protein • nutrition • immunity • HIV • developing country • prevention strategies • food additives

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