Aflatoxin analysis of blood and urine by high performance liquid chromatography in 584 Sudanese children is reported. The results in 404 malnourished children comprising 141
kwashiorkor, 111 marasmic
kwashiorkor and 152 with
marasmus are compared with 180 age-matched controls and correlated with clinical findings. The
aflatoxin detection rate and mean concentration were higher in serum of children with
kwashiorkor than the other groups. The difference between the detection rate in
kwashiorkor and controls was significant (p less than 0.05). The
aflatoxin detection rate in urine was highest in the marasmic
kwashiorkor group and the mean concentration was higher in the marasmic
kwashiorkor and marasmic groups than in the
kwashiorkor and control groups. There were important differences in the detection of certain
aflatoxins between the groups.
Aflatoxicol was detected in the sera of 16 (11.6%)
kwashiorkor, in six (6.1%) marasmic
kwashiorkor, but in none of the controls and only once in
marasmus. These differences are highly significant (p less than 0.0001). The ratio of AFB1 to AFM1 was higher in the sera and urines of
kwashiorkors than in controls, suggesting that the normal transformation of AFB1 to AFM1 may be impaired in
kwashiorkor with consequent increase in transformation of AFB1 to
aflatoxicol. The study therefore provides evidence of differences in the metabolism of
aflatoxins in children with
kwashiorkor compared with children with other forms of
malnutrition and normally nourished children and confirms the association between
aflatoxins and
kwashiorkor contained in a preliminary report on this work.