Background: Aflatoxin B1 (AFB1), AFB2, AFG1, and AFG2 are Group 1 human carcinogens, with AFB1 notably increasing hepatocellular carcinoma (HCC) risk. Sichuan Province, China, with its subtropical monsoon climate, is susceptible to AF contamination in various food items. However, the HCC disease burden attributable to lifetime chronic dietary AF intake in Sichuan has not been investigated.
Methods: The contamination data of AFB1, AFB2, AFG1, AFG2, and AFM1 across 20 food categories were analyzed from 2012 to 2023 in Sichuan. Along with the consumption data gathered from the 2011 China National Nutrition and Health Survey, the FDA-iRISK simulated the lifetime chronic dietary exposure patterns of ∑5AF and estimated the associated HCC burden using disability-adjusted life year (DALY) as the metric.
Results: As for the mean AF contamination level in food from Sichuan, the estimated lifetime average daily dose (LADD) of ∑5AF intake was 9.77 ng/kg bw/day at minimum and 26.0 ng/kg bw/day at maximum, resulting in the lifetime HCC risks per person of 0.106% and 0.283%. The corresponding HCC burdens were 16.87 DALY/100,000 people/year and 44.95 DALY/100,000 people/year, respectively. In the same scenario, the LADD and the risk of HCC in males were higher than in females, but the PAF was higher in females. However, the high (P95) AF contamination level in food caused 2-3 times higher LADD and HCC burden than the mean level of AF occurrence. Among the studied food categories, grains and their products were the primary dietary sources of dietary AF exposure.
Conclusions: Sichuan population's lifetime exposure to ∑5AF results in an HCC burden higher than the global level. It is recommended to continuously monitor and control AF contamination in Sichuan, particularly those highly vulnerable food categories, and the HCC disease burden should remain a concern in future research efforts.
Keywords: aflatoxin; dietary exposure; disability-adjusted life year; disease burden; hepatocellular carcinoma; lifetime average daily dose.