School of Food Science and Nutrition, University of Leeds, Leeds, UK.
Pakistan Council of Research in Water Resources, Islamabad, Pakistan.
Sci Rep. 2021 Jan 15;11(1):1619. doi: 10.1038/s41598-020-80356-4.
Numerous population-based studies have documented high prevalence of aflatoxin associated childhood stunting in low income countries. We provide an estimate of the disease burden of aflatoxin related stunting using data from the four African countries. For this empirical analysis, we obtained blood aflatoxin albumin adduct biomarker based exposure data as measured using ELISA technique and anthropometric measurement data from surveys done over a 12-year period from 2001 to 2012 in four low income countries in Africa. We used these data to calculate population attributable risk (PAR), life time disease burden for children under five by comparing two groups of stunted children using both prevalence and incidence-based approaches. We combined prevalence estimates with a disability weight, measuring childhood stunting and co-occurrence of stunting-underweight to produce years lived with disability. Using a previously reported mortality, years of life lost were estimated. We used probabilistic analysis to model these associations to estimate the disability-adjusted life-years (DALYs), and compared these with those given by the Institute for Health Metrics and Evaluation's Global Burden of Disease (GBD) 2016 study. The PAR increased from 3 to 36% for aflatoxin-related stunting and 14-50% for co-occurrence of stunting and underweight. Using prevalence-based approach, children with aflatoxin related stunting resulted in 48,965.20 (95% uncertainty interval (UI): 45,868.75-52,207.53) DALYs per 100,000 individuals. Children with co-occurrence of stunting and underweight due to exposure to aflatoxin resulted in 40,703.41 (95% UI: 38,041.57-43,517.89) DALYs per 100,000 individuals. Uncertainty analysis revealed that reducing aflatoxin exposure in high exposure areas upto non-detectable levels could save the stunting DALYs up to 50%. The burden of childhood all causes stunting is greater in countries with higher aflatoxin exposure such as Benin. In high exposure areas, these results might help guide research protocols and prioritisation efforts and focus aflatoxin exposure reduction. HEFCE Global Challenge Research Fund Aflatoxin project.
许多基于人群的研究记录了在低收入国家中，黄曲霉毒素与儿童发育迟缓的高患病率有关。我们使用来自四个非洲国家的数据来估计与黄曲霉毒素相关的发育迟缓的疾病负担。在这项实证分析中，我们使用 ELISA 技术获得了血液黄曲霉毒素白蛋白加合物生物标志物的暴露数据，并使用 2001 年至 2012 年期间在四个低收入非洲国家进行的调查中的人体测量数据。我们使用这些数据通过比较两组发育迟缓儿童的患病率和发病率来计算人群归因风险（PAR），并计算五岁以下儿童的终身疾病负担。我们将流行率估计值与残疾权重相结合，以衡量儿童发育迟缓以及发育迟缓-消瘦的同时发生情况，从而产生残疾生活年数。根据先前报告的死亡率，估计了失去的生命年数。我们使用概率分析对这些关联进行建模，以估计残疾调整生命年（DALYs），并将其与卫生计量与评估研究所全球疾病负担（GBD）2016 研究的结果进行比较。黄曲霉毒素相关发育迟缓的 PAR 从 3%增加到 36%，而发育迟缓与消瘦同时发生的 PAR 从 14%增加到 50%。使用患病率为基础的方法，每 100,000 人中有 48,965.20（95%不确定区间（UI）：45,868.75-52,207.53）DALYs 与黄曲霉毒素相关的发育迟缓有关。由于暴露于黄曲霉毒素而导致发育迟缓与消瘦并存的儿童每 100,000 人中有 40,703.41（95% UI：38,041.57-43,517.89）DALYs。不确定性分析表明，将高暴露地区的黄曲霉毒素暴露降低至无法检测水平，可将发育迟缓的 DALYs 减少多达 50%。在黄曲霉毒素暴露较高的国家，如贝宁，儿童所有病因发育迟缓的负担更大。在高暴露地区，这些结果可能有助于指导研究方案和优先事项，并侧重于减少黄曲霉毒素暴露。HEFCE 全球挑战研究基金黄曲霉毒素项目。
