# A Comprehensive Probabilistic Risk Assessment Strategy of Aflatoxin B1 Exposure from Medical Areca Nuts Consumption

## TL;DR

This study assesses the health risks of aflatoxin B1 in medical areca nuts in China and finds an unacceptable liver cancer risk for some consumers.

## Contribution

The first comprehensive probabilistic risk assessment combining Monte Carlo simulation with MOE and HCC strategies for AFB1 in medical areca nuts.

## Key findings

- AFB1 content in medical areca nuts ranged from 13.0 to 146.0 μg/kg.
- MOE values for AFB1 in most samples were below the safe threshold of 10,000.
- Liver cancer risk (HCC) exceeded one in a million for some consumers, indicating unacceptable risk.

## Abstract

Aflatoxin B1 (AFB1) is widely found and substantially impends public health. The current work aimed to assess AFB1 in medical areca nuts in China. The average content of AFB1 was 13.0 μg/kg, and the maximum content was 146.0 μg/kg. Furthermore, a comprehensive probabilistic risk assessment approach considering combined utilization of a Monte Carlo simulation with the margin of exposure (MOE) and quantitative liver cancer risk (HCC) strategies was developed for assessing the human health risk of AFB1 from consuming medical areca nuts for the first time. The MOE values of AFB1 in samples for no more than the 75th percentile were less than the threshold of 10,000 for both men and women. The estimated 90th percentile to the maximum of the HCC values for males and the estimated 75th percentile to the maximum of the HCC values for females were higher than one in a million upon exposure to medical areca nuts, indicating an unacceptable liver cancer risk. Sensitivity analysis demonstrated that for both MOE and HCC approaches, AFB1 content was the parameter with the greatest effects on the results, followed by the exposure frequency (EF) and daily intake rate (IR). This study is the first of this kind, demonstrating the applicability of stochastic exposure evaluation techniques for the precise and scientific assessment of the health risk of AFB1 in medical areca nuts, with the main purpose of minimizing human cancer risk.