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Yunyun Gong,¹ Assomption Hounsa,² Sharif Egal,² Paul C. Turner,¹ Anne E. Sutcliffe,¹ Andrew J. Hall,³ Kitty Cardwell,² and Christopher P. Wild¹

¹Molecular Epidemiology Unit, Centre for Epidemiology and Biostatistics, Leeds Institute of Genetics Health and Therapeutics, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom; ²International Institute of Tropical Agriculture, Cotonou, Benin, West Africa; ³London School of Hygiene and Tropical Medicine, London, United Kingdom

Abstract
Aflatoxins are dietary contaminants that are hepatocarcinogenic and immunotoxic and cause growth retardation in animals, but there is little evidence concerning the latter two parameters in exposed human populations. Aflatoxin exposure of West African children is known to be high, so we conducted a longitudinal study over an 8-month period in Benin to assess the effects of exposure on growth. Two hundred children 16-37 months of age were recruited from four villages, two with high and two with low aflatoxin exposure (50 children per village) . Serum aflatoxin-albumin (AF-alb) adducts, anthropometric parameters, information on food consumption, and various demographic data were measured at recruitment (February) and at two subsequent time points (June and October) . Plasma levels of vitamin A and zinc were also measured. AF-alb adducts increased markedly between February and October in three of the four villages, with the largest increases in the villages with higher exposures. Children who were fully weaned at recruitment had higher AF-alb than did those still partially breast-fed (p < 0.0001) ; the major weaning food was a maize-based porridge. There was no association between AF-alb and micronutrient levels, suggesting that aflatoxin exposure was not accompanied by a general nutritional deficiency. There was, however, a strong negative correlation (p < 0.0001) between AF-alb and height increase over the 8-month follow-up after adjustment for age, sex, height at recruitment, socioeconomic status, village, and weaning status ; the highest quartile of AF-alb was associated with a mean 1.7 cm reduction in growth over 8 months compared with the lowest quartile. This study emphasizes the association between aflatoxin and stunting, although the underlying mechanisms remain unclear. Aflatoxin exposure during the weaning period may be critical in terms of adverse health effects in West African children, and intervention measures to reduce exposure merit investigation. Key words: aflatoxin, biomarkers, child growth, dietary exposure, longitudinal study, weaning. Environ Health Perspect 112:1334-1338 (2004) . doi:10.1289/ehp.6954 available via http://dx.doi.org/ [Online 27 April 2004]

Address correspondence to C.P. Wild, Molecular Epidemiology Unit, Centre for Epidemiology and Biostatistics, Leeds Institute of Genetics Health and Therapeutics, Faculty of Medicine and Health, University of Leeds, Leeds, UK LS2 9JT. Telephone: 0113-343-6601. Fax: 0113-343-6603. E-mail: c.p.wild@leeds.ac.uk

We thank the following people who participated in the fieldwork: A. Agognon, Z. Assani, G. Ayeni, M. Elegbede, A. Gandjeto, M. Koube, and J. Djossou.

This study was supported by Gesellschaft für Technische Zusammenarbeit project 98.7860.4-001.00 and National Institute of Environmental Health Sciences grant ES06052.

The authors declare they have no competing financial interests.

Received 6 January 2004 ; accepted 27 April 2004.