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Association between Anemia and Aflatoxin B1 Biomarker Levels among Pregnant Women in Kumasi, Ghana

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  • Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Division of Health Promotion Sciences Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona; Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, Georgia; College of Agricultural and Environmental Services, University of Georgia, Griffin, Georgia
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Aflatoxins are fungal metabolites that contaminate staple food crops in many developing countries. Up to 40% of women attending a prenatal clinic in Africa may be anemic. In a cross-sectional study of 755 pregnant women, Aflatoxin B1-lysine adducts (AF-ALB) levels were determined by high-performance liquid chromatography. Participants were divided into quartiles “low,” “moderate,” “high,” and “very high.” Anemia was defined as hemoglobin levels < 11 g/dL. Logistic regression was used to examine the association of anemia with AF-ALB. The mean AF-ALB level was 10.9 pg/mg (range = 0.44–268.73 pg/mg); 30.3% of participants were anemic. The odds of being anemic increased 21% (odds ratio [OR], 1.21, P = 0.01) with each quartile of AF-ALB reaching an 85% increased odds in the “very high” compared with the “low” category (OR, 1.85; confidence interval [CI], 1.16–2.95). This association was stronger among women with malaria and findings were robust when women with evidence of iron deficiency anemia were excluded. This study found a strong, consistent association between anemia in pregnancy and aflatoxins.

Author Notes

*Address correspondence to Pauline E. Jolly, Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, 1665 University Blvd., Birmingham, AL 35294. E-mail: jollyp@uab.edu

Financial support: This research was supported by USAID grant LAG-G-00-96-90013-00 for the Peanut Collaborative Research Support Program, University of Georgia, Atlanta, GA.

Authors’ addresses: Faisal M. B. Shuaib, Pauline E. Jolly, Yi Jiang, Nelly J. Yatich, and Craig Wilson, Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, AL, E-mails: faisal@uab.edu, jollyp@uab.edu, howarld@uab.edu, nelly@uab.edu, and cwilson@uab.edu. John E. Ehiri, Division of Health Promotion Sciences Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, E-mail: jehiri@email.arizona.edu. William O. Ellis, Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, E-mail: elliswo@yahoo.com. Jonathan K. Stiles, Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA, E-mail: jstiles@msm.edu. Ellen Funkhouser and Sharina D. Person, Division of Preventive Medicine, Birmingham, AL, E-mails: emfunkhouser@mail.dopm.uab.edu and sperson@uab.edu. Jonathan H. Williams, College of Agricultural and Environmental Services, University of Georgia, Griffin, GA, E-mail: twillia@griffin.uga.edu.

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