TY - JOUR
T1 - Aflatoxin exposure and mortality in acutely ill children
T2 - Results from the CHAIN network cohort
AU - Xia, Lei
AU - Wu, Hang
AU - Saleem, Ali Faisal
AU - Mupere, Ezekiel
AU - Lancioni, Christina
AU - Diallo, Hama
AU - Potani, Isabel
AU - Ali, Syed Asad
AU - Voskuijl, Wieger
AU - Chisti, Mohammod Jobayer
AU - Shahid, Abu Sadat Mohammad Sayeem Bin
AU - Timbwa, Molline
AU - Mwaringa, Shalton
AU - Tigoi, Caroline
AU - Ngari, Moses
AU - Singa, Benson
AU - Tickell, Kirkby D.
AU - Njunge, James
AU - Bandsma, Robert
AU - Ahmed, Tahmeed
AU - Berkley, James
AU - Walson, Judd L.
AU - Gong, Yunyun
AU - Routledge, Michael N.
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.
PY - 2025/7/17
Y1 - 2025/7/17
N2 - Background Chronic exposure to aflatoxins is associated with liver cancer, impaired child growth, and compromised immune function. The Childhood Acute Illness and Nutrition (CHAIN) Network cohort was established to identify risk factors for mortality in acutely ill children admitted to nine hospitals in four African and two South Asian countries. We examined the role of aflatoxin exposure in inpatient and post-discharge mortality. Methods In a nested case-cohort from the CHAIN cohort, we compared aflatoxin exposure at admission and discharge with death or survival in hospital (n=755) or up to 180-days post-discharge (n=585) and with community participants (CP, n=222). Children were stratified into non-wasting, medium-wasting and severe-wasting groups based on mid-upper arm circumference. Serum samples were analysed for an aflatoxin exposure biomarker, the aflatoxin-albumin adduct (AF-alb) using ELISA. Findings Overall, 56% of hospitalised participants tested positive for AF-alb at admission. The AF-alb level was higher in deceased (geometric mean and 95% CI (GM and 95% CI) 5.9 (4.9 to 7.1)) than in survivors (4.2 (3.8 to 4.7)) and CP (3.7 (3.1 to 4.3)) pg/mg alb. AF-alb concentration was higher at admission (4.7, (4.2 to 5.1)) than at discharge (3.7, (3.3 to 4.1)) and in the CP group (3.7, (3.1 to 4.3)) pg/mg alb (p<0.01) and in African vs Asian children (7.4 (6.5 to 8.5) vs 1.9 (1.8 to 2.1)) (p<0.001). Adjusted logistical regression showed no significant association between AF-alb levels and mortality, but after separating the nutrition strata, AF-alb was significantly associated with mortality (highest vs lowest quartile group OR=4.84, p=0.014) in non-wasted children. Interpretation Moderate to severe malnutrition is a more important risk factor for mortality than aflatoxin in acutely ill children, but aflatoxin exposure may contribute to mortality in non-wasted children. Controlling aflatoxin exposure should be integrated into clinical and public health interventions to reduce mortality in areas with high levels of exposure. Funding Bill and Melinda Gates Foundation (OPP1131320 & INV-003225).
AB - Background Chronic exposure to aflatoxins is associated with liver cancer, impaired child growth, and compromised immune function. The Childhood Acute Illness and Nutrition (CHAIN) Network cohort was established to identify risk factors for mortality in acutely ill children admitted to nine hospitals in four African and two South Asian countries. We examined the role of aflatoxin exposure in inpatient and post-discharge mortality. Methods In a nested case-cohort from the CHAIN cohort, we compared aflatoxin exposure at admission and discharge with death or survival in hospital (n=755) or up to 180-days post-discharge (n=585) and with community participants (CP, n=222). Children were stratified into non-wasting, medium-wasting and severe-wasting groups based on mid-upper arm circumference. Serum samples were analysed for an aflatoxin exposure biomarker, the aflatoxin-albumin adduct (AF-alb) using ELISA. Findings Overall, 56% of hospitalised participants tested positive for AF-alb at admission. The AF-alb level was higher in deceased (geometric mean and 95% CI (GM and 95% CI) 5.9 (4.9 to 7.1)) than in survivors (4.2 (3.8 to 4.7)) and CP (3.7 (3.1 to 4.3)) pg/mg alb. AF-alb concentration was higher at admission (4.7, (4.2 to 5.1)) than at discharge (3.7, (3.3 to 4.1)) and in the CP group (3.7, (3.1 to 4.3)) pg/mg alb (p<0.01) and in African vs Asian children (7.4 (6.5 to 8.5) vs 1.9 (1.8 to 2.1)) (p<0.001). Adjusted logistical regression showed no significant association between AF-alb levels and mortality, but after separating the nutrition strata, AF-alb was significantly associated with mortality (highest vs lowest quartile group OR=4.84, p=0.014) in non-wasted children. Interpretation Moderate to severe malnutrition is a more important risk factor for mortality than aflatoxin in acutely ill children, but aflatoxin exposure may contribute to mortality in non-wasted children. Controlling aflatoxin exposure should be integrated into clinical and public health interventions to reduce mortality in areas with high levels of exposure. Funding Bill and Melinda Gates Foundation (OPP1131320 & INV-003225).
KW - Global Health
UR - https://www.scopus.com/pages/publications/105011311891
U2 - 10.1136/bmjgh-2024-017375
DO - 10.1136/bmjgh-2024-017375
M3 - Article
AN - SCOPUS:105011311891
SN - 2059-7908
VL - 10
JO - BMJ Global Health
JF - BMJ Global Health
IS - 7
M1 - e017375
ER -
