The prevalence of aflatoxin M1 in milk of Middle East region: A systematic review, meta-analysis and probabilistic health risk assessment

The current investigation was undertaken to take a review of the performed studies regarding the concentration and prevalence of aflatoxin M-1 (AFM(1)) of the consumed cow milk in the Middle East. In this context, all available studies published in databases include Science Direct, PubMed, Scopus, and Web of Science among 1995 to December 2017; were screened accordingly. Also, the carcinogenic risk was estimated by calculating hazard index (HI) using the Monte Carlo simulation (MCS). The result of conducted meta-analysis for 49 articles containing 7484 data indicated that the rank order of type of milk based on the concentration of aflatoxin M-1 was Ultra-high temperature processing (UHT) milk (82.57 ng/kg) > raw milk (60.37 ng/kg) > pasteurized milk (PAS) (45.81 ng/kg). The pooled concentration of aflatoxin M-1 in raw and UHT milk was higher than EC (European Committee, 50 ng/kg) standard limit. The rank order of countries based on the concentration of aflatoxin M-1 in raw milk was Syria > Turkey > Iran > Egypt > Lebanon > Palestine; pasteurized milk, Turkey > Iran > Lebanon; and UHT milk, Iran > Turkey > Saudi Arabia. The overall prevalence of aflatoxin M-1 in the raw milk of Iran, Turkey, Lebanon, Palestine, Egypt, and Syria was identified as 76%, 12%, 67%, 85%, 38%, and 14%; pasteurized milk, in the Iran, Lebanon, and Turkey was 77%, 36%, and 11%; and finally UHT milk in Iran, Saudi Arabia, and Turkey was 81%, 82%, and 62%, respectively. HI in the adult's consumer's raw milk in the Iran, Turkey, Syria, Palestine, Lebanon, and Egypt were calculated as 0.26, 0.47, 0.52, 0.34, 0.23 and 0.18; However, the HI for adult consumers of pasteurized milk in the Iran, Turkey, and Lebanon were 0.28, 0.31 and 0.11. Also, the measured HI for adult consumers of UHT milk in the Saudi Arabia, Turkey, and Iran was 0.20, 0.33 and 0.50, respectively. The obtained HI for consumers of raw milk in the children age group of the Iran, Turkey, Syria, Palestine, Lebanon, and Egypt were 1.03, 2.20, 2.42, 1.59, 1.05, and 0.84. The calculated HI for consumers of pasteurized milk in the children age group of the pasteurized milk in of Iran, Turkey, and Lebanon were 1.30, 1.56, and 0.50. Finally, in term of UHT milk in Saudi Arabia, Turkey, and Iran were 0.94, 1.44 and 2.35, respectively. Unlike Adults, children consumers in the several Middle East countries are at considerable cancer risk due to consumption of raw, pasteurized and UHT milk contain AFM(1)(HI > 1).