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, 18 (1), 1247

Impaired Growth in Rural Gambian Infants Exposed to Aflatoxin: A Prospective Cohort Study


Impaired Growth in Rural Gambian Infants Exposed to Aflatoxin: A Prospective Cohort Study

Sinead Watson et al. BMC Public Health.


Background: Exposure to aflatoxin, a mycotoxin produced by fungi that commonly contaminates cereal crops across sub-Saharan Africa, has been associated with impaired child growth. We investigated the impact of aflatoxin exposure on the growth of Gambian infants from birth to two years of age, and the impact on insulin-like growth factor (IGF)-axis proteins.

Methods: A subsample (N = 374) of infants from the Early Nutrition and Immune Development (ENID) trial (ISRCTN49285450) were included in this study. Aflatoxin-albumin adducts (AF-alb) were measured in blood collected from infants at 6, 12 and 18 months of age. IGF-1 and IGFBP-3 were measured in blood collected at 12 and 18 months. Anthropometric measurements taken at 6, 12, 18 and 24 months of age were converted to z-scores against the WHO reference. The relationship between aflatoxin exposure and growth was analysed using multi-level modelling.

Results: Inverse relationships were observed between lnAF-alb and length-for-age (LAZ), weight-for-age (WAZ), and weight-for-length (WLZ) z-scores from 6 to 18 months of age (β = - 0·04, P = 0·015; β = - 0·05, P = 0.003; β = - 0·06, P = 0·007; respectively). There was an inverse relationship between lnAF-alb at 6 months and change in WLZ between 6 and 12 months (β = - 0·01; P = 0·013). LnAF-alb at 12 months was associated with changes in LAZ and infant length between 12 and 18 months of age (β = - 0·01, P = 0·003; β = - 0·003, P = 0·02; respectively). LnAF-alb at 6 months was associated with IGFBP-3 at 12 months (r = - 0·12; P = 0·043).

Conclusions: This study found a small but significant effect of aflatoxin exposure on the growth of Gambian infants. This relationship is not apparently explained by aflatoxin induced changes in the IGF-axis.

Keywords: Aflatoxin; Biomarker; Child growth; Insulin-like growth factor; The Gambia.

Conflict of interest statement

Ethics approval and consent to participate

Ethical approval for the ENID trial, the ENID-Growth add-on and this sub-study was obtained by the joint Gambian Government/Medical Research Council (MRC) Unit The Gambia ethics committee. Additional approval for this sub-study was obtained from the University of Leeds ethics committee. Written informed consent was obtained from all participants.

Consent for publication

Not applicable.

Competing interests

All authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.


Fig. 1
Fig. 1
Flow diagram of infants included and excluded in ENID and in this analysis. Abbreviation: SAM, severe acute malnutrition
Fig. 2
Fig. 2
Anthropometric z scores at 0, 6, 12, 18 and 24 months of age. Abbreviations: WAZ, weight for age z-score; LAZ, length for age z-score; and WLZ, weight for length z-score. Values are means ±95% CIs
Fig. 3
Fig. 3
Geometric mean (95% CI) AF-alb concentrations at 6, 12 and 18 months of age, and seasonal differences in AF-alb concentrations. Total = geometric mean AF-alb concentrations; wet = geometric mean AF-alb concentrations measured in blood samples collected during the wet season (June to October); dry = geometric mean AF-alb concentrations measured in blood samples collected during the dry season (November to May). Seasonal differences (wet vs. dry) in lnAF-alb concentrations were analysed using independent samples t-test

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