Risk of dietary and breastmilk exposure to mycotoxins among lactating women and infants 2–4 months in northern India.

Mycotoxins are carcinogenic secondary metabolites of fungi that have been linked to
infant growth faltering. In this study, we quantified co-occurring mycotoxins in breast
milk and food samples from Haryana, India, and characterized determinants of exposure.
Deterministic risk assessment was conducted for mothers and infants. We
examined levels of eight mycotoxins (Aflatoxin B1, B2, G1, G2, M1, M2; Ochratoxin A,
B) in 100 breast milk samples (infants 2–4 months) using ultra-high-performance liquid
chromatography tandem mass spectrometry. Aflatoxin B1 (AFB1), fumonisin B1
(FB1) and deoxynivalenol (DON) were detected in several food items (n = 298) using
enzyme-linked immunosorbent assays. We report novel data on the presence of
mycotoxins in breast milk samples from India. Whereas breast milk concentrations
(AFM1 median: 13.7; range: 3.9–1200 ng/L) remain low, AFM1 was detected above
regulatory limits in 27% of animal milk samples. Additionally, 41% of infants were
above provisional maximum tolerable daily intake (PMTDI) limits for AFM1 due to
consumption of breast milk (mean: 3.04, range: 0.26–80.7 ng kg−1 bw day−1). Maternal
consumption of breads (p < 0.05) was associated with breast milk AFM1 exposure.
AFB1 (μg/kg) was detected in dried red chilies (15.7; 0–302.3), flour (3.13; 0–214.9),
groundnuts (0; 0–249.1), maize (56.0; 0–836.7), pearl millet (1.85; 0–160.2), rice
(0; 0–195.6), wheat (1.9; 0–196.0) and sorghum (0; 0–63.5). FB1 (mg/kg) was
detected in maize (0; 0–61.4), pearl millet (0; 0–35.4) and sorghum (0.95; 0–33.2).
DON was not detected in food samples. Mothers in our study exceeded PMTDI recommendations
for AFB1 due to consumption of rice and flour (mean: 75.81; range:
35.2–318.2 ng kg−1 bw day−1). Our findings show the presence of Aflatoxin B1 and
M1 at various levels of the food chain and in breast milk, with estimated intakes
exceeding PMTDI recommendations. Aflatoxins are known carcinogens and have also
been linked to stunting in children. Their presence across the food system and in
breast milk is concerning, thus warranting further research to replicate and expand
on our findings and to understand implications for maternal and child health.