A worldwide systematic literature review for aflatoxin M1 in infant formula milk: Human health risk assessment by Monte Carlo simulation

Mycotoxins, predominantly aflatoxin M1 (AFM1), require better quality control in infant formula milk (IFM). This study aims to use a systematic review study to estimate the amount and health risk assessment of AFM1 of IFM for infants less than one year old in the last two decades worldwide. For this purpose, a systematic search was conducted from June 27, 2000, to April 5, 2021. Two hundred and twelve articles and reports were obtained from various databases, and twenty of them were eventually chosen for the current study based on the study's selection criteria. Due to a lack of access to the raw data of the studies obtained, EXCEL re-simulated the data of each of these studies, keeping in mind the mean, standard deviation, and sample size of each study. The statistical analysis, health risk assessment, uncertainty analysis, and sensitivity analysis for AFM1 of IFM were then done on the simulated data by country, continent, and globally. Based on the compliance of AFM1 of IFM with the European Community (EC) standard (25 ng/kg), and also according to the results of health risk assessment, the quality of IFM provided to the market in most countries in the last two decades in terms of the AFM were at a high level and has been unauthorized. Therefore, it is necessary to pay special attention to continuous monitoring and control measures for AFM1 in consumer IFM over all countries worldwide. Due to the limited current information about AFM1 of IFM in the world, further studies are necessary.

Automated summary

This study used a systematic review to estimate the amount and health risk assessment of aflatoxin M1 (AFM1) in infant formula milk (IFM) for infants less than one year old worldwide over the past two decades. Results showed that the quality of IFM in most countries has been at a high level in terms of AFM1. Therefore, it is necessary to pay special attention to continuous monitoring and control measures for AFM1 in consumer IFM globally.