University of Vienna, Faculty of Chemistry, Department of Food Chemistry and Toxicology, Währinger Straße 38, 1090 Vienna, Austria.
Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria; Channing Division of Network Medicine, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Environ Int. 2020 Sep;142:105845. doi: 10.1016/j.envint.2020.105845. Epub 2020 Jun 17.
Early-life development of infants may be critically affected by man-made or natural contaminants including mycotoxins. However, data on the occurrence of food contaminants in breast milk is scarce and prohibits a comprehensive exposure and risk assessment for mothers and their infants. Here, we present a longitudinal exposure assessment over the first 211 days of a single newborn girl (studyA) by measuring multiple mycotoxins in milk. Eighty-seven consecutive breast milk samples were obtained from the newborn's mother living in Austria and following a regular mixed diet. Mycotoxins were analyzed by utilizing a highly sensitive LC-MS/MS approach covering 29mycotoxins and key metabolites. In addition to this longitudinal study, three mothers provided breast milk samples each on five consecutive days, for a preliminary comparison of inter-day and inter-individual variation in exposures (studyB). StudyA revealed that mycotoxin occurrence in breast milk was limited to the emerging mycotoxins alternariol monomethyl ether (AME), beauvericin (BEA), enniatins (A, A, B, B) and to ochratoxin A (OTA), which is regulated in commercial infant food. These mycotoxins were, if present, mostly detected at very low concentrations (<10 ng/L), except AME which exceeded this concentration on two distinct days by a factor of 3x and 5x. Overall, longitudinal results indicated chronic low-dose exposure to the detected mycotoxins. Other regulated mycotoxins including the carcinogenic aflatoxins or the estrogenic zearalenone and their biotransformation products were absent in all tested samples. StudyB confirmed the results of studyA, with minimal inter-day and inter-individual variation. In addition, a preliminary correlation of OTA levels occurring in breast milk and matched urine samples was found (r = 0.64, p = 0.034) in study B. Based on the data set obtained in studyA, exposure of the infant was estimated. Exposure estimates of individual mycotoxins were on average below 1 ng/kg body weight per day. Our preliminary findings suggest that recommended maximum daily intake levels might not be exceeded in the Austrian population. However, exposure is likely to be higher in populations with lower food safety standards. In the light of co-occurrence of several emerging mycotoxins in breast milk, future studies should address low-dose mixture effects. This also includes other environmental contaminants which may be present in this bio-fluid and should involve an exposome-scale risk assessment. All these efforts must be intended to minimize exposure of mothers and infants in a window of high susceptibility.
婴儿的早期发育可能会受到人为或自然污染物（包括霉菌毒素）的严重影响。然而，关于母乳中食物污染物的发生的数据很少，因此无法对母亲及其婴儿进行全面的暴露和风险评估。在这里，我们通过测量牛奶中的多种霉菌毒素，对一名新生女婴（研究 A）的前 211 天进行了纵向暴露评估。该研究的婴儿母亲生活在奥地利，饮食混合，我们从她那里获得了 87 份连续的母乳样本。我们利用一种高灵敏度的 LC-MS/MS 方法分析了 29 种霉菌毒素及其关键代谢物。除了这项纵向研究外，还有三位母亲在连续五天内各提供了一次母乳样本，初步比较了暴露的日内和个体间差异（研究 B）。研究 A 表明，母乳中霉菌毒素的出现仅限于新兴霉菌毒素 alternariol monomethyl ether (AME)、 beauvericin (BEA)、 enniatins (A, A, B, B) 和 ochratoxin A (OTA)，后者在商业婴儿食品中受到监管。这些霉菌毒素，如果存在，大多以非常低的浓度（<10ng/L）检测到，除了 AME 在两天内分别高出 3 倍和 5 倍。总体而言，纵向结果表明存在慢性低剂量暴露于检测到的霉菌毒素。在所有测试样本中均未发现其他受监管的霉菌毒素，包括致癌的黄曲霉毒素或雌激素玉米赤霉烯酮及其生物转化产物。研究 B 证实了研究 A 的结果，日内和个体间的差异最小。此外，在研究 B 中还发现了母乳和匹配尿液样本中 OTA 水平之间的初步相关性（r=0.64，p=0.034）。基于在研究 A 中获得的数据，估计了婴儿的暴露量。个体霉菌毒素的暴露估计值平均低于每天 1 纳克/公斤体重。我们的初步研究结果表明，在奥地利人群中，可能不会超过推荐的最大日摄入量水平。然而，在食品安全标准较低的人群中，暴露量可能更高。鉴于母乳中同时存在几种新兴霉菌毒素，未来的研究应解决低剂量混合物的影响。这还包括可能存在于这种生物液体中的其他环境污染物，应涉及暴露组规模的风险评估。所有这些努力都必须旨在尽量减少在高易感期内母亲和婴儿的暴露。
