Adv. Nutr. 3: 526–531, 2012.
Food Chain Mycotoxin Exposure, Gut Health, and Impaired Growth: A Conceptual Framework
Laura E. Smith,2* Rebecca J. Stoltzfus,2 and Andrew Prendergast3
2Division of Nutritional Sciences, Cornell University, Ithaca, NY; Queen Mary University of London, UK; and 3Zvitambo Project, Harare, Zimbabwe
Abstract – Childhood stunting is an important and intractable public health problem that underlies approximately 20% of deaths among children aged <5 y in developing countries. Environmental enteropathy (EE), a subclinical condition of the small intestine characterized by reduced absorptive capacity and increased intestinal permeability, is almost universal among children in developing countries and may mediate stunting. However, the etiology of EE is poorly understood. Mycotoxins are metabolites of fungi that frequently contaminate the staple foods of children living in developing countries. We review evidence from human and animal studies that exposure to mycotoxins, particularly aflatoxin (AF), fumonisin (FUM), and deoxynivaenol (DON), may impair child growth. Although these toxins have distinct actions, they all mediate intestinal damage through: 1) inhibition of protein synthesis (AF, DON); 2) an increase in systemic proinflammatory cytokines (DON); and 3) inhibition of ceramide synthase (FUM). The intestinal pathology that arises from mycotoxin exposure is very similar to that of EE. We propose that future studies should address the role of mycotoxins in the pathogenesis of EE and evaluate interventions to limit mycotoxin exposure and reduce childhood stunting.
