This book provides an evaluation of measures to reduce exposure to highly toxic and carcinogenic contaminants in staple diets in Africa as well as parts of Asia and Latin America. Many of the poorest people in these regions are exposed to the pervasive natural toxins, aflatoxins and fumonisins, on a daily basis by eating their staple diet of groundnuts, maize, and other cereals. Exposure to mycotoxins at these high levels substantially increases mortality and morbidity. Aflatoxins are a cause of human liver cancer, and fatalities from acute aflatoxin poisoning outbreaks occur in Africa and Asia.

The International Agency for Research on Cancer convened a Working Group of world-leading experts to review the health effects of aflatoxins and fumonisins and to evaluate intervention measures. The panel concluded that these mycotoxins not only are a cause of acute poisoning and cancer but also are a likely contributor to the high levels of stunting in children in affected populations. The Working Group also identified effective measures to reduce exposure in developing countries.

The panel evaluated 15 interventions, considering the strength of the evidence as well as its completeness and its transferability at an individual, community, or national level. Four of the interventions were judged to be ready for implementation: improvement of dietary diversity; crop sorting; post-harvest measures, including improved storage; and, in Latin America for maize, optimized nixtamalization. These recommendations would be relevant for investment of public, nongovernmental organization, and private funds at the scale of the subsistence farmer, the smallholder, and through to a more advanced value chain.

Contents

• Working Group members
• Acknowledgements
• Executive Summary
• CHAPTER 1. Human exposure to aflatoxins and fumonisins
  • Exposure to aflatoxins
  • Exposure to fumonisins
  • Biomarkers for aflatoxins and fumonisins
  • Co-occurrence of aflatoxins and fumonisins
  • Analytical limitations
  • Key scientific gaps
• CHAPTER 2. Child stunting in developing countries
  • Prevalence of child malnutrition
  • Risk factors for child malnutrition
  • Interventions against child malnutrition
  • Key scientific gaps and research needs
• CHAPTER 3. Effects of aflatoxins on aflatoxicosis and liver cancer
  • Acute aflatoxin poisoning
  • Hepatocellular carcinoma
• CHAPTER 4. Effects of aflatoxins and fumonisins on child growth
  • Studies of pre- or postnatal aflatoxin exposure and postnatal growth
  • Studies of maternal aflatoxin exposure and birth outcomes
  • Studies of postnatal fumonisin exposure and infant growth
  • Scientific gaps and future research needs
• CHAPTER 5. Fetal and neonatal toxicities of aflatoxins and fumonisins
  • Aflatoxins
  • Fumonisins
  • In utero exposure to fumonisin in humans: scientific gaps and research needs
• CHAPTER 6. Effects of aflatoxins and fumonisins on the immune system and gut function
  • Aflatoxins
  • Fumonisins
• CHAPTER 7. Intervention strategies to reduce human exposure to aflatoxins and fumonisins
  • Regulation
  • Dietary diversity to mitigate mycotoxin exposure
  • Genetic resistance to aflatoxin and fumonisin contamination of maize
  • Genetic resistance to aflatoxin contamination of groundnuts
  • Biological control of aflatoxins
  • Sorting
  • Nixtamalization
  • Post-harvest storage intervention strategies to reduce aflatoxin and fumonisin exposure
  • Interventions useful in emergencies
  • Chemoprevention studies
• Disclosures of interests
• References

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©International Agency for Research on Cancer, 2015

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Cover image: Spreading groundnuts for sun-drying prior to storage in Guinea (Credit: C.P. Wild/IARC).

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