Aflatoxin M1 in human breast milk: A global systematic review, meta-analysis, and risk assessment study (Monte Carlo simulation)

Background: In this current study, a systematic review and meta-analysis in a global scale regarding the prevalence and concentration of aflatoxin M-1 (AFM(1)) in the human breast milk were conducted based on the socioeconomic indexes and amounts of precipitation. Scope and approach: All available studies published in PubMed, Scopus, Web of sciences and Embase databases were screened between 1 January 1983 and 25 December 2017. Also, the probabilistic carcinogenic risk by the hazard index (HI) in the Monte Carlo simulation (MCS) was calculated. Key findings and conclusions: The meta-analysis of 57 papers containing 196 studies showed that the minimum and maximum concentrations of AFM(1) in human breast milk was noted in Sierra Leone (0.80 ng/L) and the United Arab Emirates (UAE) (465.76 ng/L), respectively. The lowest prevalence of AFM(1) in human breast milk was reported in Brazil (2%) while the highest was observed in the Gambia similar to Tanzania similar to Jordan (100%). The minimum and maximum concentrations of AFM(1) in human breast milk were observed in America (10.30 ng/L) and South-East Asia continents (358.99 ng/L), respectively. Also, the lowest and highest prevalence of AFM(1) in human breast milk was observed in the West Pacific (7%) and Africa (52%) continents, respectively. According to findings, with increasing average rain annual and poverty (GDP ranking), the prevalence of AFM(1) in human breast milk significantly (P-value < 0.05) increased. Moreover, the prevalence of AFM(1) in human breast milk significantly (P-value < 0.05) decreased with over time (Among the selected period; 1983 and 2017) which can be correlated with improvements in hygienic conditions as well as public awareness regarding the contamination of food products by AFM(1). The health risk assessment indicated that except for one month's infant in the UAE and Thailand, all infants' consumer of human breast milk in the world is not at considerable risk (HI < 1).