Aflatoxin M1 in milk does not contribute substantially to global liver cancer incidence

Nikita Saha Turna; Arie Havelaar; Adegbola Adesogan; Felicia Wu

doi:10.1093/ajcn/nqac033

Aflatoxin M1 in milk does not contribute substantially to global liver cancer incidence

Am J Clin Nutr. 2022 Jun 7;115(6):1473-1480. doi: 10.1093/ajcn/nqac033.

Authors

Nikita Saha Turna^{1

2}, Arie Havelaar^{3

4

5}, Adegbola Adesogan^{3

4}, Felicia Wu^{1

6}

Affiliations

¹ Department of Food Science & Human Nutrition, Michigan State University, East Lansing, MI, USA.
² British Columbia Centre for Disease Control, Vancouver, BC, Canada.
³ Department of Animal Sciences, University of Florida, Gainesville, FL, USA.
⁴ Food Systems Institute, University of Florida, Gainesville, FL, USA.
⁵ Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA.
⁶ Department of Agricultural, Food, and Resource Economics, Michigan State University, East Lansing, MI, USA.

PMID: 35470382
DOI: 10.1093/ajcn/nqac033

Abstract

Background: For 60 y, it has been known that aflatoxin B1 (AFB1), a mycotoxin produced by Aspergillus fungi in certain food and feed crops, causes hepatocellular carcinoma (liver cancer; HCC) in humans. The annual global burden of AFB1-related HCC has been estimated. However, much less is known about the potential carcinogenic impact of a metabolite of AFB1 called aflatoxin M1 (AFM1), which is secreted in milk when dairy animals consume AFB1-contaminated feed. The cancer risk of AFM1 to humans from milk consumption has not yet been evaluated.

Objectives: We sought to estimate the global risk of AFM1-related liver cancer through liquid milk consumption, accounting for possible synergies between AFM1 and chronic infection with hepatitis B virus (HBV) in increasing cancer risk.

Methods: We conducted a quantitative cancer risk assessment by analyzing extensive datasets of national population sizes, dairy consumption patterns, AFM1 concentrations in milk in 40 nations, and chronic HBV prevalence. Two separate cancer risk assessments were conducted: assuming a possible synergy between AFM1 and HBV in increasing cancer risk in a manner similar to that of AFB1 and HBV, and assuming no such synergy.

Results: If there is no synergy between AFM1 and HBV, AFM1 may contribute ∼0.001% of total annual HCC cases globally. If there is synergy between AFM1 and HBV infection, AFM1 may contribute ∼0.003% of all HCC cases worldwide. In each case, the total expected AFM1-attributable cancer cases are ∼13-32 worldwide.

Conclusion: AFM1 exposure through liquid milk consumption does not substantially increase liver cancer risk in humans. Policymakers should consider this low risk against the nutritional benefits of milk consumption, particularly to children, in a current global situation of milk being discarded because of AFM1 concentrations exceeding regulatory standards.

Keywords: aflatoxin M1; dairy; liver cancer; regulatory standards; risk assessment.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Aflatoxin B1 / analysis
Aflatoxin B1 / toxicity
Aflatoxin M1 / analysis
Animal Feed / analysis
Animals
Carcinoma, Hepatocellular* / epidemiology
Carcinoma, Hepatocellular* / etiology
Food Contamination / analysis
Humans
Incidence
Liver Neoplasms* / epidemiology
Liver Neoplasms* / etiology
Milk / chemistry

Substances

Aflatoxin M1
Aflatoxin B1