Infants and young children in the Democratic Republic of the Congo (DRC) may be highly exposed to dietary mycotoxins due to reliance on maize flour-based complementary foods. This cross-sectional study assessed exposure across urban and rural health zones in South Kivu, DRC. A total of 428 maize flour samples were pooled into 48 composite samples and analyzed using validated LC-MS/MS methods. Dietary exposure was assessed using Estimated Daily Intake (EDI), Margin of Exposure (MoE), Monte Carlo simulations, and liver cancer risk modeling. Children under five were exposed to levels of aflatoxin B 1 (AFB 1 ; EDIs > 200 ng/kg bw/day) exceeding safety limits. MoE values (1.1-23.1) were far below the recommended threshold of 10,000, indicating high carcinogenic risk. The children were also exposed to fumonisins (0.03-0.74 µg/kg bw/day), deoxynivalenol (0-0.44 µg/kg bw/day), and zearalenone (0-0.50 µg/kg bw/day). Cumulative risk was highest in white (hazard index, HI = 297.8) and pale red maize flours (HI = 275.4). White maize flour contributed the highest AFB1-related liver cancer burden (3.05 cases per 100,000 children annually). These results highlight the need for food safety surveillance and for targeted myotoxin mitigation programs. • LC-MS/MS revealed multi-mycotoxins contamination in maize flour consumed in South Kivu by Infant and Young Children • Infants had high AFB1 exposure levels exceeding safety limits, with EDIs of 230 ng/kg bw/day in infants (0 - 11 months) and 210 ng/kg bw/day in toddlers (12 - 23 months) • MoE values from 1.1 to 23.1, far below the recommended threshold of 10,000, indicating high carcinogenic risk • Fumonisins, DON, and ZEN widely co-occurred in samples • White maize flour posed the highest cumulative health risk with HI of 297.8 • White maize flour contributed the highest AFB₁-related liver cancer burden with 3.05 cases per 100,000 children annually
Miderho et al. (Wed,) studied this question.