Systematic review and meta-analysis of adverse health effects associated with mycotoxin exposure

IF 10.2 1区环境科学与生态学 Q1 ENVIRONMENTAL SCIENCES

Environment International Pub Date : 2026-10-01 Epub Date: 2026-09-28 DOI:10.1016/j.envint.2026.110540

Tess Goessens, Yasmine Bader, Febe Vertriest, Kokeb Tesfamariam, Sarah De Saeger, Carl Lachat, Marthe De Boevre

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引用次数: 0

Abstract

Background

Mycotoxins, toxic fungal metabolites present in food, are an increasing global health concern expected to intensify with climate change and shifting dietary patterns.

Aim

This review systematically identified, appraised, and synthesized primary research on human health effects associated with exposure to single and multiple mycotoxins, aiming to clarify current evidence, uncertainties, and research gaps.

Methods

Following the PECO framework, Embase, Cochrane Library, PubMed, Web of Science, and Scopus were searched from inception to May 2025 for studies reporting measured or modelled mycotoxin exposure and human health outcomes. Non-human, mechanistic, review, and grey literature were excluded. Three reviewers independently screened studies, with duplicate full-text assessment. Risk of bias was evaluated using OHAT and certainty of evidence with GRADE. Sensitivity analyses, publication bias assessment, and non-quantitative evidence were synthesized using Cochrane effect-direction plots. Random-effects meta-analyses assessed associations between aflatoxin exposure and seven health outcomes.

Results

Of 55,342 records, 268 studies met inclusion criteria, covering 17 mycotoxin groups and 71 health outcomes. Liver disease, particularly hepatocellular carcinoma, and kidney disease were the most frequently investigated outcomes, with most studies conducted in Africa and Asia. Qualitative synthesis demonstrated predominantly positive associations between mycotoxin exposure and neurological, metabolic, oncological, renal, reproductive, and developmental disorders. Certainty of evidence was very low for all 21 assessed outcomes, reflecting the predominance of cross-sectional designs and substantial between-study inconsistency. Quantitative meta-analyses of 42 studies identified associations between aflatoxin exposure and hepatocellular carcinoma, liver cirrhosis, elevated ALT, and gallbladder cancer.

Conclusion

Evidence supports associations between mycotoxin exposure and multiple health risks; however, heterogeneity in study design, exposure assessment, and outcome reporting highlights the need for more rigorous and harmonized research across diverse populations.

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与霉菌毒素暴露相关的不良健康影响的系统评价和荟萃分析。

背景：真菌毒素，即存在于食物中的有毒真菌代谢物，是一个日益严重的全球健康问题，预计将随着气候变化和饮食模式的转变而加剧。目的：本综述系统地识别、评价和综合了与暴露于单一和多种真菌毒素有关的人类健康影响的初步研究，旨在澄清当前的证据、不确定性和研究空白。方法：根据PECO框架，检索Embase、Cochrane图书馆、PubMed、Web of Science和Scopus，从建立到2025年5月，报告测量或模拟霉菌毒素暴露和人类健康结果的研究。非人类、机械、综述和灰色文献被排除在外。三位审稿人独立筛选研究，并进行重复的全文评估。偏倚风险采用OHAT评估，证据确定性采用GRADE评估。敏感性分析、发表偏倚评估和非定量证据采用Cochrane效应方向图进行综合。随机效应荟萃分析评估了黄曲霉毒素暴露与七种健康结果之间的关系。结果：在55,342项记录中，268项研究符合纳入标准，涵盖17个霉菌毒素组和71个健康结局。肝脏疾病，特别是肝细胞癌和肾脏疾病是最常见的调查结果，大多数研究在非洲和亚洲进行。定性合成证明真菌毒素暴露与神经、代谢、肿瘤、肾脏、生殖和发育障碍之间存在显著正相关。所有21个评估结果的证据确定性都很低，反映了横断面设计的优势和研究之间的大量不一致。42项研究的定量荟萃分析确定了黄曲霉毒素暴露与肝细胞癌、肝硬化、ALT升高和胆囊癌之间的关联。结论：有证据支持霉菌毒素暴露与多种健康风险之间存在关联；然而，研究设计、暴露评估和结果报告的异质性突出了在不同人群中进行更严格和协调的研究的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Environment International 环境科学-环境科学

CiteScore

21.90

自引率

3.40%

发文量

734

审稿时长

2.8 months

期刊介绍： Environmental Health publishes manuscripts focusing on critical aspects of environmental and occupational medicine, including studies in toxicology and epidemiology, to illuminate the human health implications of exposure to environmental hazards. The journal adopts an open-access model and practices open peer review. It caters to scientists and practitioners across all environmental science domains, directly or indirectly impacting human health and well-being. With a commitment to enhancing the prevention of environmentally-related health risks, Environmental Health serves as a public health journal for the community and scientists engaged in matters of public health significance concerning the environment.