Mycotoxins and human disease: a largely ignored global health issue

Aflatoxins and fumonisins (FB) are mycotoxins contaminating a large fraction of the world's food, including maize, cereals, groundnuts and tree nuts. The toxins frequently co-occur in maize. Where these commodities are dietary staples, for example, in parts of Africa, Asia and Latin America, the contamination translates to high-level chronic exposure. This is particularly true in subsistence farming communities where regulations to control exposure are either non-existent or practically unenforceable. Aflatoxins are hepatocarcinogenic in humans, particularly in conjunction with chronic hepatitis B virus infection, and cause aflatoxicosis in episodic poisoning outbreaks. In animals, these toxins also impair growth and are immunosuppressive; the latter effects are of increasing interest in human populations. FB have been reported to induce liver and kidney tumours in rodents and are classified as Group 2B 'possibly carcinogenic to humans', with ecological studies implying a possible link to increased oesophageal cancer. Recent studies also suggest that the FB may cause neural tube defects in some maize-consuming populations. There is a plausible mechanism for this effect via a disruption of ceramide synthase and sphingolipid biosynthesis. Notwithstanding the need for a better evidence-base on mycotoxins and human health, supported by better biomarkers of exposure and effect in epidemiological studies, the existing data are sufficient to prioritize exposure reduction in vulnerable populations. For both toxins, there are a number of practical primary and secondary prevention strategies which could be beneficial if the political will and financial investment can be applied to what remains a largely and rather shamefully ignored global health issue.

Association between tortilla consumption and human urinary fumonisin B1 levels in a Mexican population

Fumonisins are mycotoxins produced by Fusarium spp. and commonly contaminate maize and maize products worldwide. Fumonisins are rodent carcinogens and have been associated with human esophageal cancer. However, the lack of a valid exposure biomarker has hindered both the assessment of human exposure and the evaluation of disease risk. A sensitive liquid chromatography-mass spectrometry method to measure urinary fumonisin B1 (FB1) following extraction on Oasis MAX cartridges was established and applied to urine samples from women in a cohort recruited in Morelos County, Mexico. Urinary FB1 was compared with dietary information on tortilla consumption. FB1 recovery in spiked samples averaged 94% as judged by deuterium-labeled FB1 internal standard. Urinary FB1 was determined in 75 samples from women selected based on low, medium, or high consumption of maize-based tortillas. The geometric mean (95% confidence interval) of urinary FB1 was 35.0 (18.8-65.2), 63.1 (36.8-108.2), and 147.4 (87.6-248.0) pg/mL and the frequency of samples above the detection limit (set at 20 pg FB1/mL urine) was 45%, 80%, and 96% for the low, medium, and high groups, respectively. Women with high intake had a 3-fold higher average FB1 levels compared with the "low intake" group (F = 7.3; P = 0.0015). Urinary FB1 was correlated with maize intake (P-trend = 0.001); the correlation remained significant after adjusting for age, education, and place of residence. This study suggests that measurement of urinary FB1 is sufficiently sensitive for fumonisin exposure assessment in human populations and could be a valuable tool in investigating the associated health effects of exposure.

Holocene climate change and past Irish societal response

The extent to which North Atlantic Holocene climatic perturbations influenced past human societies is an area of considerable uncertainty and fierce debate. Ireland is ideally placed to help resolve this issue, being occupied for over 9000 yr and located on the eastern Atlantic seaboard, a region dominated by westerly airflow. Irish bog and lake tree populations provide unambiguous evidence of major shifts in surface moisture through the Holocene similar to cycles recorded in the marine realm of the North Atlantic, indicating significant changes in the latitude and intensity of zonal atmospheric circulation across the region. To test for human response to these cycles we summed the probabilities of 465 radiocarbon ages obtained from Irish archaeological contexts and observe enhanced archaeological visibility during periods of sustained wet conditions. These results suggest either increasing density of human populations in key, often defensive locations, and/or the development of subsistence strategies to overcome changing conditions, the latter recently proposed as a significant factor in avoiding societal collapse. Regardless, we demonstrate environmental change is a significantly more important factor in influencing human activity in the landscape than has hitherto been acknowledged.

Glycemic index, carbohydrate and fiber intakes and risk of reflux esophagitis, Barrett’s esophagus, and esophageal adenocarcinoma

Objective: To examine the association between dietary glycemic index (GI), glycemic load (GL), total carbohydrate, sugars, starch, and fiber intakes and the risk of reflux esophagitis, Barrett’s esophagus, and esophageal adenocarcinoma.

Methods: In an all-Ireland study, dietary information was collected from patients with esophageal adenocarcinoma (n = 224), long-segment Barrett’s esophagus (n = 220), reflux esophagitis (n = 219), and population-based controls (n = 256). Multiple logistic regression analysis examined the association between dietary variables and disease risk by tertiles of intake and as continuous variables, while adjusting for potential confounders.

Results: Reflux esophagitis risk was positively associated with starch intake and negatively associated with sugar intake. Barrett’s esophagus risk was significantly reduced in people in the highest versus the lowest tertile of fiber intake (OR 0.44 95%CI 0.25–0.80). Fiber intake was also associated with a reduced risk of esophageal adenocarcinoma, as was total carbohydrate intake (OR 0.45 95%CI 0.33–0.61 per 50 g/d increase). However, an increased esophageal adenocarcinoma risk was detected per 10 unit increase in GI intake (OR 1.42 95%CI 1.07–1.89).

Conclusions: Our findings suggest that fiber intake is inversely associated with Barrett’s esophagus and esophageal adenocarcinoma risk. Esophageal adenocarcinoma risk is inversely associated with total carbohydrate consumption but positively associated with high GI intakes.

Impact of PSA testing and prostatic biopsy on cancer incidence and mortality: comparative study between the Republic of Ireland and Northern Ireland

Objectives: To investigate the impact of different PSA testing policies and health-care systems on prostate cancer incidence and mortality in two countries with similar populations, the Republic of Ireland (RoI) and Northern Ireland (NI).

Methods: Population-level data on PSA tests, prostate biopsies and prostate cancer cases 1993–2005 and prostate cancer deaths 1979–2006 were compiled. Annual percentage change (APC) was estimated by joinpoint regression.

Results: Prostate cancer rates were similar in both areas in 1994 but increased rapidly in RoI compared to NI. The PSA testing rate increased sharply in RoI (APC = +23.3%), and to a lesser degree in NI (APC = +9.7%) to reach 412 and 177 tests per 1,000 men in 2004, respectively. Prostatic biopsy rates rose in both countries, but were twofold higher in RoI. Cancer incidence rates rose significantly, mirroring biopsy trends, in both countries reaching 440 per 100,000 men in RoI in 2004 compared to 294 in NI. Median age at diagnosis was lower in RoI (71 years) compared to NI (73 years) (p < 0.01) and decreased significantly over time in both countries. Mortality rates declined from 1995 in both countries (APC = -1.5% in RoI, -1.3% in NI) at a time when PSA testing was not widespread.

Conclusions: Prostatic biopsy rates, rather than PSA testing per se, were the main driver of prostate cancer incidence. Because mortality decreases started before screening became widespread in RoI, and mortality remained low in NI, PSA testing is unlikely to be the explanation for declining mortality.

Confirming the Existence of Gaps and Depletions in the Irish Oak Tree-Ring Record

In the course of building the 7000 year Belfast long oak chronology a series of depletion problems were encountered. These problems were overcome by 1984 when the completion of the long chronology was announced. The solution to the bridging of the various ‘gaps’ in the Irish chronology lay in the use of long sections of oak chronology from Britain. Now that a quarter of a century has elapsed and large numbers of additional oak samples, and site assemblages, have been accumulated it seems reasonable to review the ‘gaps’ in order to see if the Irish chronology could now be constructed without the use of British material. That is, are the depletion periods in the Irish chronology still evident, and if so, what might they imply about past conditions and human populations? The perhaps surprising conclusion is that the original depletions are still evident after 25 years of quasi-random sampling by archaeologists and palaeoecologists throughout Ireland.

Iron intake and markers of iron status and risk of Barrett's esophagus and esophageal adenocarcinoma

Objective To investigate the association between iron intake and iron status with Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC).

Resource pressure and environmental change on the North African littoral: Epipalaeolithic to Roman gastropods from Cyrenaica, Libya.

This paper discusses the marine and terrestrial shell on Epipalaeolithic to Classical-period sites in the Cyrenaican coastlands, northeast Libya, with particular reference to the Haua Fteah, with parallel studies at a late-Roman farmstead and two small caves. Together they provide evidence for coastal and terrestrial environments and for the continued nutritional importance of gastropods to humans during the Holocene. Land snail evidence is consistent with regional vegetation in coastal Cyrenaica becoming increasingly open through the Holocene, as a result of some combination of climate change and human impact. Marine species suggest that the coastline near the Haua had been rocky throughout the Holocene. At Hagfet al-Gama, changing faunas provide evidence for sand encroachment onto a previously rocky shoreline in Hellenistic times. A biometric study of Osilinus turbinatus shows that in the archaeological sites these shells are systematically smaller than modern specimens, providing evidence for long-term dietary stress in the human populations around the Haua Fteah, with particularly severe stress in parts of the Epipalaeolithic. A biometric study of Patella spp. provided evidence for size selection, but also seems to show evidence for resource pressure. It is unlikely that variations in resource pressure seen in the mollusc biometrics are the result of climatic stress or natural ecological factors and explanations must be sought in society-environment dynamics.