Tomerak Rania H, Shaban Hala H, Khalafallah Osama A, El Shazly Maha N
Paediatrics and Neonatology, Department of Paediatrics bDepartment of Clinical Pathology, Faculty of Medicine cCentre of Social and Preventive Medicine, Cairo University, Cairo, Egypt.
J Egypt Public Health Assoc. 2011;86(3-4):51-5. doi: 10.1097/01.EPX.0000399138.90797.40.
Mothers are exposed to many toxins that can reach their infants through breast milk. One of these toxins is aflatoxins, produced by Aspergillus fungus. Aspergillus colonizes grains, especially in tropical regions where there is high temperature and humidity. Aflatoxins are highly toxic, mutagenic, teratogenic, and carcinogenic. One of these is aflatoxin B1 that is excreted in breast milk as aflatoxin M1 (AFM1).
This is a cross-sectional study in which 150 mother-infant dyads were included. All the infants were exclusively breastfed. Infant weights' standard deviation scores were documented at birth and at 6 months. At 6 months, before starting weaning, AFM1 was measured in breast milk by enzyme-linked immunosorbent assay and by liver enzymes; alanine aminotransferase (ALT) and aspartate aminotransferase (AST) for all mothers and infants.
Ninety-eight mothers (65.3%) had AFM1-positive breast milk samples (AFM1>0.05 μg/l according to the European Community and Codex Alimentarius). AFM1 levels ranged between 0.2 and 19.0 μg/l (mean: 7.1±5.0 μg/l). In cases considered negative, AFM1 levels ranged between 0.01and 0.05 μg/l (mean: 0.04±0.01 μg/l). Infants of AFM1-positive mothers had lower weight standard deviation scores at birth and at 6 months (P=0.04 and 0.0001). ALT and aspartate aminotransferase of mothers and ALT of infants were significantly higher in dyads having AFM1-positive breast milk (P=0.0001, 0.0001, and 0.03, respectively).
Aflatoxins represent a real threat in Egypt. The higher liver enzymes in AFM1-positive cases might represent an alarm toward future development of hepatocellular carcinoma.
Cooperation of ministries is recommended to combat this problem. The public should be educated about proper food storage and about the hazards of aflatoxin ingestion.
母亲会接触到许多毒素，这些毒素可通过母乳传递给婴儿。其中一种毒素是黄曲霉毒素，由曲霉菌产生。曲霉菌会在谷物上定殖，尤其是在高温高湿的热带地区。黄曲霉毒素具有高毒性、致突变性、致畸性和致癌性。其中一种是黄曲霉毒素B1，它会以黄曲霉毒素M1（AFM1）的形式在母乳中排泄出来。
这是一项横断面研究，纳入了150对母婴。所有婴儿均为纯母乳喂养。记录婴儿出生时和6个月时体重的标准差分数。在6个月时，断奶开始前，通过酶联免疫吸附测定法和肝酶检测母乳中的AFM1；检测所有母亲和婴儿的丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（AST）。
98名母亲（65.3%）的母乳样本AFM1呈阳性（根据欧洲共同体和食品法典委员会标准，AFM1>0.05μg/l）。AFM1水平在0.2至19.0μg/l之间（平均：7.1±5.0μg/l）。在被认为呈阴性的病例中，AFM1水平在0.01至0.05μg/l之间（平均：0.04±0.01μg/l）。AFM1阳性母亲的婴儿在出生时和6个月时的体重标准差分数较低（P=0.04和0.0001）。母乳AFM1呈阳性的母婴组中，母亲的ALT和天冬氨酸氨基转移酶以及婴儿的ALT显著更高（分别为P=0.0001、0.0001和0.03）。
黄曲霉毒素在埃及构成了真正的威胁。AFM1阳性病例中较高的肝酶水平可能是肝细胞癌未来发展的一个警示信号。
建议各部委合作应对这一问题。应向公众宣传正确的食品储存方法以及摄入黄曲霉毒素的危害。
