Association between aflatoxin exposure and health characteristics, liver function, hepatitis and malaria infections in Ghanaians

Purpose. We examined the relationship between various health parameters and aflatoxin B1 (AFB1) albumin adduct levels in plasma. Design. A cross-sectional field study was conducted in four villages in the Ashanti region of Ghana. Methods. A survey on socio-demographic and health characteristics was administered to 162 volunteers and blood (20 ml) was donated by 140 participants. AFB1 albumin adduct levels, liver function, hepatitis B and C viruses (HBV, HCV) and malaria infections were determined. Results. AFB1 levels ranged from 0.12 to 2.995 pmol mg-1 albumin (mean ± standard deviation = 0.89 ± 0.46) and was categorized based on the median as low (<0.80 pmol mg-1) or high (≥0.80 pmol mg-1) and used in the analyses. By multivariate analysis, significantly higher levels of AFB1 were obtained for participants who reported symptoms of acute aflatoxicosis: history of yellow mouth (odds ratio = 5.5, confidence interval = 1.04-29.07, p = 0.04); history of sore swollen stomach (odds ratio = 4.54, confidence interval = 1.28-15.62, p = 0.01). A history of painful vomiting was marginally associated (p = 0.09) with high AFB1 levels. Between 30 and 40% of the study group had abnormal liver function and HBV/HCV infections. Total protein and alanine transaminase (ALT) were positively correlated to AFB1 levels (p<0.01 and p = 0.02, respectively). For every unit increase in AFB1, total protein increased by 0.27 units and ALT increased by 0.20 units. HBV was associated with high AFB1 levels (p = 0.055) and HCV was marginally associated with low AFB1 levels (p = 0.08). Approximately 20% of study participants were positive for malaria antigen in blood. A number of symptoms and disease markers were not significantly associated with AFB1. Conclusions. These results show high levels of AFB1 and symptoms of acute aflatoxicosis in a population that also has high levels of HBV/HCV infections and abnormal liver function. Thus, a high proportion of these study participants are at significant risk of developing hepatocellular carcinoma. © 2007 Informa UK Ltd.