The occurrence of mycotoxins in breast milk, fruit products and cereal-based infant formula: a review

Background: Breast milk is considered an essential food segment for children up to 6 months; however, it can be contaminated with some mycotoxins, such as aflatoxin M1 (AFM1) and ochratoxin A (OTA) as a consequence of ingestion of dietary mycotoxins by lactating mothers. Moreover, the health of infants can be threatened due to simultaneous exposure to a mixture of mycotoxins mainly due to their potential synergistic effects. Scope and approach: An overview of the prevalence of mycotoxins in breast milk and infant formula, fruit- and cereal-based products as routine diets of infants during the last 10 years, besides the associated health risks, were presented. In this regard, the relevant citations published in international databases such as PubMed, Science direct from 2008 to 2019 were screened by the aid of a systematic review approach. Key findings and conclusions: The high prevalence of AFM1 and OTA in breast milk reported in several countries highlighted the extent of mycotoxin occurrence in the diet of lactating mothers. Furthermore, the exposure rates of infants to mycotoxins in breast milk and infant formula while generated a margin of exposure values lower than 10,000, indicating a huge public health concern. Thus, reducing the dietary exposure of mycotoxins for lactating mothers and approaching the required controlling steps during the processing and distribution of infant formulas are crucial. Further studies are recommended to evaluate the health risks to infants due to dietary exposure to multiple mycotoxins in infant foods.Highlights: Assessment of 73 studies on mycotoxin occurrence in breast milk and infant foods during 2008–2019; AFM1 and OTA were the main occurring mycotoxins in breast milk and infant foods; High health risks associated with the exposure of children to dietary aflatoxins; Co-occurrence of mycotoxins in fruit products and cereal-based infant formula should be a concern.The authors would like to thank Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) for the fellowship (Grant #2017/12956-2). A.S. Sant'Ana acknowledges the financial support from CNPq (Grant #302763/2014-7, #305804/2017-0) and CAPES (Financial code 01). This work was also supported by the National Institute of Health Dr. Ricardo Jorge, Projeto Incentivo de Estudos de Biomonitorização Humana de Âmbito Nacional | BioMAN [BioMAN/DAN/01] and CESAM, through the Fundação para a Ciência e a Tecnologia [UID/AMB/50017/2013], national funds, and the co-funding by the FEDER [POCI-01-0145-FEDER-00763], within the PT2020 Partnership.