Aflatoxin M1 in human breast milk: A global systematic review, meta-analysis, and risk assessment study (Monte Carlo simulation)

Background In this current study, a systematic review and meta-analysis in a global scale regarding the prevalence and concentration of aflatoxin M1 (AFM1) in the human breast milk were conducted based on the socioeconomic indexes and amounts of precipitation. Scope and approach All available studies published in PubMed, Scopus, Web of sciences and Embase databases were screened between 1 January 1983 and 25 December 2017. Also, the probabilistic carcinogenic risk by the hazard index (HI) in the Monte Carlo simulation (MCS) was calculated. Key findings and conclusions The meta-analysis of 57 papers containing 196 studies showed that the minimum and maximum concentrations of AFM1 in human breast milk was noted in Sierra Leone (0.80 ng/L) and the United Arab Emirates (UAE) (465.76 ng/L), respectively. The lowest prevalence of AFM1 in human breast milk was reported in Brazil (2%) while the highest was observed in the Gambia ∼ Tanzania ∼ Jordan (100%). The minimum and maximum concentrations of AFM1 in human breast milk were observed in America (10.30 ng/L) and South-East Asia continents (358.99 ng/L), respectively. Also, the lowest and highest prevalence of AFM1 in human breast milk was observed in the West Pacific (7%) and Africa (52%) continents, respectively. According to findings, with increasing average rain annual and poverty (GDP ranking), the prevalence of AFM1 in human breast milk significantly (P-value