# Comparison of Aflatoxin Contamination and Dietary Exposure From Complementary Foods Among Rural Tanzanian Infants Enrolled in the Mycotoxin Mitigation Trial

## TL;DR

This study shows that providing low-aflatoxin flours to infants in Tanzania significantly reduced their exposure to harmful aflatoxins compared to usual practices.

## Contribution

The study demonstrates the effectiveness of low-aflatoxin flours in reducing infant dietary exposure to aflatoxins in a real-world setting.

## Key findings

- Intervention arm had lower aflatoxin levels in groundnut and blended flours compared to the control arm.
- Estimated aflatoxin ingestion was significantly reduced in the intervention group.
- Extremely high aflatoxin intake levels were absent in the intervention arm.

## Abstract

Dietary aflatoxins (AF) exposure in early childhood may contribute to growth restriction. The Mycotoxin Mitigation Trial (MMT) was a cluster‐randomized trial designed to assess the effect of providing low‐AF maize and groundnut flours (intervention) on infant growth compared to those consuming typically available flours (standard of care [SoC]). The SoC serves as a control, representing the normal frequency and concentration ranges of AF in this region. MMT initiated at infant age 6 months and ended at 18 months, with the intervention group receiving low‐AF flours monthly throughout. This sub‐study served as one check point in the MMT to assess if there was a difference in AF frequency and concentration in high‐risk foods between the two arms. At the MMT midpoint (infant age 12 months), infant foods were collected during household visits within 20 pre‐selected clusters (10/arm). Maize/groundnut blend and groundnut flours used in the preparation of foods consumed by infants were analyzed for total AFs by ELISA, with 10% confirmed by HPLC. In total 559 foods were sampled; sampling was on one occasion per household. Chi‐square test was used to compare categories of AF contamination in infant foods, and an unpaired t‐test was used to compare both contamination by arm, and to compare estimates of AF ingestion between arms. In the intervention arm, 23% of groundnut flour and 6% of blended flour samples had AF levels greater than 10 μg/kg, the legal limit in Tanzania, compared to 45% and 43%, respectively, in the SoC (control) arm (p < 0.05). Further, estimated ingestion of AF was lower for the low‐AF supplied blended flours (p = 0.03) and groundnut (p = 0.04). Importantly, the extremely high levels of AF ingestion (> 1000 ng/kg bw/day) observed in the SoC arm were absent in the intervention arm. The provision of low‐AF flours in the intervention households reduced the frequency and concentrations of AF contamination compared to the SoC, and thus reduced the estimated dietary exposure to infants, at the midpoint of the trial.

The Mycotoxin Mitigation Trial (MMT) followed infants from age 6 months to age 18 months. In one arm all infants were provided with aflatoxin safe flours (maize/groundnut mix and groundnut) for complementary feeding throughout; while the other arm undertook their usual practice, Standard of Care arm. Comparison of estimated aflatoxin intake at the midpoint revealed that the intervention effectively removed the high intake estimates by more than 10‐fold for maize/groundnut mix and 57‐fold for groundnut.