Probabilistic dietary based estimation of the burden of aflatoxin-induced hepatocellular carcinoma among adult Malawians

The risk of aflatoxin-induced hepatocellular carcinoma (HCC) among adults (average body weight of 60 kg) in Malawi was assessed based on aflatoxin B₁ (AFB₁) exposure through groundnut and maize consumption, by Monte Carlo simulation. The risk (cases per year per 100,000 people) of aflatoxin-induced HCC was estimated based on the AFB₁ exposures estimated by this study and hepatitis B virus infection prevalence published for Malawi. AFB₁ exposures were estimated by probabilistically combining data of AFB₁ contamination in 338 groundnut and 604 maize samples with data of per capita groundnut and maize consumption in 274 households. Aflatoxins in the samples were analysed using validated LC-MS/MS, HPLC and VICAM based methods. The groundnut and maize consumption survey was based on household expenditure technique. The simulated mean AFB₁ exposures through consumption of groundnuts, maize, and combination thereof were 28±65, 42±174, and 71±211 ng/kg. body weight (bw)/day, respectively. The estimated HCC risks were 1.26±2.72, 1.86±6.66 and 3.10±6.85 cases per 100,000 persons per year, respectively. Further, hypothetical eradication of hepatitis B virus (HBV) reduced the risk of HCC by 78%. This reaffirms the need for integrating HBV vaccination in the fight of aflatoxin induced HCC.