Mycotoxins and human disease: a largely ignored global health issue Original paper

What was reviewed?

This narrative review examined the global health impact of two major foodborne mycotoxins—aflatoxins and fumonisins—and synthesized evidence linking chronic dietary exposure to human disease, with a particular focus on carcinogenesis and preventable exposure pathways. The authors argue that mycotoxin exposure is a “largely ignored” public health problem because contamination disproportionately affects staple foods in low-income regions (maize, groundnuts, cereals, nuts), where regulation is often absent or unenforceable. The review details mechanistic toxicology (metabolism, DNA damage, biomarkers), epidemiologic links to human cancers, emerging evidence for non-cancer outcomes (immune effects, growth impairment, neural tube defects), and practical prevention strategies across pre-harvest, storage, processing, and chemopreventive approaches.

Who was reviewed?

The review drew primarily on human epidemiologic and biomarker studies conducted in populations with high dietary exposure to contaminated staple crops, especially subsistence-farming and maize-consuming communities in sub-Saharan Africa, China, Southeast Asia, and Latin America. For aflatoxins, key evidence came from cohort and case–control studies in Taiwan, Shanghai, The Gambia, Benin/Togo, Guinea, and Kenya, often incorporating biomarkers such as aflatoxin–albumin adducts, urinary metabolites (e.g., AFM1, AFB1-N7-Gua), and TP53 codon 249ser mutations. For fumonisins, the review highlighted exposure studies and ecological cancer correlations in South Africa, China, Mexico, and the Texas–Mexico border region, plus mechanistic and carcinogenicity data from rodent and other animal models.

Most important findings

The authors concluded that aflatoxins and fumonisins create distinct but overlapping disease risks in heavily exposed communities, and that co-contamination of maize can compound harm. Aflatoxin B1 is established as a human hepatocarcinogen, acting through hepatic bioactivation to an epoxide that forms mutagenic DNA adducts and a characteristic TP53 codon 249ser mutation; risk is strongly amplified by chronic hepatitis B virus infection, with multiple studies showing markedly elevated hepatocellular carcinoma odds when both exposures are present. Biomarker-based evidence demonstrates near-universal exposure in some West African settings, including children, and supports additional outcomes such as episodic fatal aflatoxicosis, potential immune suppression, and growth impairment. Fumonisin B1 is a proven animal carcinogen (liver/kidney) and a “possibly carcinogenic” human exposure, with ecological evidence linking high fumonisin maize contamination to esophageal cancer and emerging concern for neural tube defects via inhibition of ceramide synthase and sphingolipid disruption; however, human biomarker tools (e.g., Sa:So ratio) have been insufficiently sensitive in many field studies, complicating causal inference. The review emphasizes that prevention is feasible: improved storage and sorting/washing can substantially reduce exposure, and chemopreventive approaches (e.g., chlorophyllin, oltipraz, clays) can reduce aflatoxin biomarkers in trials.

Key implications

For clinicians and microbiome-signature database builders, this review reinforces that diet-derived fungal toxins are powerful, mechanistically grounded exposures that may confound or drive disease-associated microbial patterns, particularly in maize-dependent regions. Aflatoxin exposure—measurable through validated biomarkers—should be considered alongside HBV status when evaluating liver disease and cancer risk, and may plausibly influence immune function and growth trajectories in children, shaping host–microbe interactions. For fumonisins, the key translational gap is measurement: improved exposure biomarkers (e.g., urinary FB1 by LC–MS and newer sphingoid-based markers) are essential to clarify human disease links, including congenital outcomes. The most actionable message is prevention: low-cost post-harvest storage improvements, sorting/washing, and culturally appropriate food-processing interventions can substantially lower exposure and should be integrated into public health and clinical risk-reduction strategies in high-burden settings.

Citation

Wild CP, Gong YY. Mycotoxins and human disease: a largely ignored global health issue. Carcinogenesis. 2010;31(1):71-82. doi:10.1093/carcin/bgp264