AFLATOXINS IN BODY FLUIDS AND FOOD OF NIGERIAN CHILDREN WITH PROTEIN- ENERGY MALNUTRITION Onyemelukwe

Aflatoxins are natural contaminants of food crops implicated in the pathogenesis of various human diseases. This study aimed to determine the associations between aflatoxins and proteinenergy malnutrition (PEM) by measurements of aflatoxins in serum, urine and food on plate of Nigerian children with PEM. A crosssectional study was undertaken in 3 agroecological regions of Nigeria (Guinea savannah, Sudan savannah and Rain forest), where aflatoxins B1, B2, G1, G2, M1, and M2 were measured in sera, urine and food on plate of 79 children with PEM (kwashiorkor n=36, marasmic kwashiorkor n=29 and marasmus n=13) and 33 healthy controls, matched for age and sex. Among healthy controls, aflatoxin detection rates were higher in the Guinea Savannah (72.2%) than in the Sudan Savannah (53.8%), albeit statistically insignificant. In relation to nutritional groups, the rates of detection of aflatoxins were higher in marasmic kwashiorkor (93.1%) and kwashiorkor patients (88.9%), compared to marasmus (76.9%) and controls (63.6%, p=0.013). The rates of detection of B1 aflatoxin followed a similar trend viz. marasmic kwashiorkor (82.4%), kwashiorkor (69.4%), marasmus (53.8%) and controls (42.4%, p=0.007). Of all types of aflatoxins detected in serum, M2 had the highest rates of detection in all patient groups and controls. The median concentrations of aflatoxins detected in sera of each PEM group were significantly higher than those of controls, but comparisons between PEM groups were not statistically significant. The frequency and concentration of aflatoxins detected in urine and food of PEM groups and controls were not statistically different. However, controls had the lowest serum /urine aflatoxin ratio as well as lowest median aflatoxins concentrations in their food as compared to PEM patients. In conclusion, aflatoxins are commonly detected in the body fluids and food of Nigerian children, but more frequently and at higher concentrations in children with PEM, possibly due to decreased excretion or increased exposure. Future prospective studies are desirable to determine if aflatoxins contribute to the pathogenesis of all types of PEM and not necessarily kwashiorkor alone.