Background
Materials and methods
Search strategy
Data extraction
Quality assessment
Statistical analysis
Results
Study characteristics
Reference | Year | Study design | Location | N of participants | Age (rang or mean ± sd) | Exposure | Exposure assessment | Mean serum AFB1(mean ± sd, or as mentioned) | Outcomes | Statistical models | Adjustment |
---|---|---|---|---|---|---|---|---|---|---|---|
Alamua et al. | 2019 | Cross-sectional | Zambia | 311 | 6–24 months | AFB1-lysine (serum) | HPLC | 0.21 ± 0.75 ng/mL | Stunting, underweight | Logistic regression | Sex, sickness, age, serum albumin |
Andrews-Trevino et al. | 2021 | Prospective cohort | Nepal | 1484 | 3 to 22 months | AFB1-lysine (serum) | HPLC | 1.27 pg/mg albumin (95%CI: 1.18–1.36) | Stunting, height, WHZ, WAZ, HAZ | Logistic regression Linear regression | Age, season of measurement, and detectable AFB1 concentrations (yes/no) |
Ashraf et al. | 2022 | Cross-sectional | Pakistan | 238 | 1–11 years | AFB1-lysine (serum) | HPLC | 11.27 pg/mg albumin (95%CI: 15.88–24.17) | Stunting, underweight, wasting | Logistic regression | Adjusted for potential covariates(not reported) |
Mahfuz et al. | 2020 | Prospective cohort | Bangladesh | 228 | 7–36 months | AFB1-lysine (serum) | HPLC | 3.70 pg/mg albumin (range: 0.09 -126.54) | HAZ, Stunting | Logistic regression Linear regression | Sex, concentrations of myeloperoxidase in stool, low birth weight, maternal height, number of people sleep in one room, improved toilet, treatment of drinking water, asset categories |
Andrews‐Trevino et al. | 2021 | Prospective cohort | Nepal | 699 | 18–22 months | AFB1-lysine (serum) | HPLC | 2.41 ± 7.88 pg/mg albumin | Stunting, underweight, height, WAZ, HAZ | Logistic regression Linear regression | Length, weight or anthropometric z‐scores at birth or head circumference at 3 months, child's minimum dietary diversity (yes/no) and mother's schooling |
Shirima et al. | 2015 | Prospective cohort | Tanzania | 166 | 6–14 months | AFB1-lysine (serum) | ELISA | 4.7 pg/mg albumin (95%CI: 3.9—5.6) | Height, HAZ | Multivariable regression | Village, breastfeeding, maternal education, and family socioeconomic status and protein and energy intakes, sex, baseline age in month, and baseline length |
Tessema et al. | 2021 | Prospective cohort | Ethiopia | 102 | 6–35 months | AFB1-lysine (serum) | HPLC | NR | WHZ, HAZ | Linear regression | child’s sex, age, time of assessment (pre- or post-harvest), intervention arm, inflammation, household wealth tertile and incidence of diarrhea |
Watson et al. | 2018 | Prospective cohort | Gambia | 374 | 6–18 months | AFB1-lysine (serum) | ELISA | 52.29 ± 5.61 pg/mg albumin | WHZ, WAZ, HAZ | Linear regression | Season of sampling, mother’s household quality, supplementation group, and age of introduction of non-breast milk foods |
Turner et al. | 2007 | Prospective cohort | Gambia | 138 | Under 1 year | AFB1-lysine (serum) | ELISA | 8.7 pg/mg albumin ( range: 5.0—30.2) | WAZ, HAZ | The generalized estimating equations multiple regression | Gender, age, placental weight, maternal weight, gestation duration and season |
Gong et al. | 2003 | Cross-sectional | Benin and Togo | 479 | 9 months to 5 years | AFB1-lysine (serum) | ELISA | 32.8 pg/mg albumin (95% CI: 25.3—42.5) | WAZ, HAZ | Multivariable regression | Age, sex, socioeconomic status, agro ecological zone, and weaning status |
McMillana et al. | 2018 | Case–control | Nigeria | 58 | 6 – 48 months | AFB1-lysine (serum) | HPLC | 2.6 pg/mg albumin (range: 0.2—59.2) | Stunting, WHZ, HAZ | Logistic regression Spearman's correlations | Age |
Wangia-Dixon et al. | 2020 | Cross-sectional | Kenya | 748 | 6–12 years | AFB1-lysine (serum) | HPLC | 10.5 pg/mg albumin (95%CI: 9.4 -11.7) | WHZ, WAZ, HAZ | Linear regression | County, age of child, go to bed and feel hungry, age of mother when she had first child, marital status, living condition, and mother’s education |
Shouman et al. | 2011 | Cross-sectional | Egypt | 46 | 1 month to 4.5 years | AFB1 (serum) | TLC | 51.61 ppm ( interquartile range: 30.565 -62.795) | WAZ, HAZ | Spearman’s correlation | Not adjusted |
Castelino et al. | 2015 | Cross-sectional | Kenya | 199 | 12.0 ± 3.0 years | AFB1-lysine (serum) | ELISA | 110.5 pg/mg albumin (95%CI: 95.4 -127.9) | Height | Multivariable regression | Age, sex, school, liver disease state and infection status |
Matchado et al. | 2023 | Prospective cohort | Malawi | 241 | Under 30 months | AFB1-lysine (serum) | IDMS | NR | WHZ, WAZ, HAZ | Linear regression | Maternal prepregnancy body mass index, HIV, weight and mid-upper-arm-circumference-for-age z-score gain rate from baseline to 36 weeks, housing quality, food security, child sex, age, malaria, hemoglobin |
AFB1 exposure and growth measurements
Test of association | Test of heterogeneity | |||||
---|---|---|---|---|---|---|
Continuous outcome | Subgroup | Studies | β | 95%CI | I2 (%) | P |
Height | Overall | 4 | -0.17 | -0.25 to -0.09 | 19.0 | 0.29 |
Prospective cohort | 3 | -0.21 | -0.30 to -0.12 | 0.0 | 0.60 | |
Non-cohort | 1 | -0.10 | -0.20 to -0.001 | - | - | |
HPLC | 2 | -0.20 | -0.29 to -0.12 | 0.0 | 0.44 | |
ELISA | 2 | -0.14 | -0.31 to 0.03 | 26.0 | 0. 24 | |
HAZ | Overall | 12 | -0.17 | -0.30 to -0.03 | 97.2 | < 0.001 |
Prospective cohort | 8 | -0.05 | -0.10 to -0.01 | 58.2 | 0.01 | |
Non-cohort | 4 | -0.33 | -0.75 to 0.10 | 99.0 | < 0.001 | |
HPLC | 6 | -0.02 | -0.10 to 0.05 | 73.3 | 0.002 | |
ELISA | 4 | -0.31 | -0.70 to 0.08 | 98.9 | < 0.001 | |
TLC | 1 | -0.46 | -0.69 to -0.22 | - | - | |
IDMS | 1 | -0.18 | -0.32 to -0.04 | - | - | |
Adjusted | 11 | -0.14 | -0.29 to -0.001 | 97.4 | < 0.001 | |
Not-adjusted | 1 | -0.46 | -0.69 to -0.22 | - | - | |
WAZ | Overall | 8 | -0.18 | -0.33 to -0.02 | 97.9 | < 0.001 |
Prospective cohort | 5 | -0.05 | -0.07 to -0.03 | 4.3 | 0.38 | |
Non-cohort | 3 | -0.32 | -0.69 to 0.05 | 96.7 | < 0.001 | |
HPLC | 3 | -0.06 | -0.11 to -0.02 | 41.1 | 0.18 | |
ELISA | 3 | -0.33 | -0.78 to 0.12 | 99.3 | < 0.001 | |
TLC | 1 | -0.20 | -0.48 to 0.08 | - | - | |
IDMS | 1 | -0.03 | -0.17 to 0.11 | - | - | |
Adjusted | 7 | -0.17 | -0.34 to -0.01 | 98.2 | < 0.001 | |
Not-adjusted | 1 | -0.20 | -0.48 to 0.08 | 43.2 | 0.17 | |
WHZ | Overall | 6 | -0.02 | -0.07 to 0.03 | 43.6 | 0.11 |
Prospective cohort | 4 | -0.01 | -0.07 to 0.04 | 59.6 | 0.06 | |
Non-cohort | 2 | -0.07 | -0.27 to 0.13 | 18.7 | 0.26 | |
HPLC | 4 | -0.01 | -0.05 to 0.03 | 0.0 | 0.50 | |
ELISA | 1 | -0.06 | -0.10 to -0.02 | - | - | |
IDMS | 1 | 0.09 | -0.04 to 0.22 | - | - | |
Dichotomous outcome | Subgroup | Studies | Odds ratio | 95%CI | I2 (%) | P |
Stunting | Overall | 6 | 1.15 | 0.98 to 1.35 | 80.3 | < 0.001 |
Prospective cohort | 3 | 1.21 | 1.11 to 1.33 | 0.0 | 0.50 | |
Non-cohort | 3 | 1.14 | 0.80 to 1.63 | 43.5 | 0.15 | |
Underweight | Overall | 3 | 1.08 | 0.92 to 1.27 | 70.6 | 0.03 |
Prospective cohort | 1 | 1.20 | 1.03 to 1.40 | - | - | |
Non-cohort | 2 | 0.99 | 0.98 to 1.00 | 0.0 | 0.37 | |
Wasting | Overall | 1 | 1.00 | 0.98 to 1.02 | - | - |