Systematic review and meta-analysis on the prevalence and concentration of aflatoxin B1 in Iranian wheat flour: health risk assessment.
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Wheat flour is a nutritionally complete food that can be affected by fungal attacks, leading to mycotoxins contamination and posing serious health risks. Therefore, the aim of the present study was to investigate the prevalence and determine the concentration of AFB1 in Iranian wheat flour. In the current meta-analysis, a systematic search was conducted based on the PRISMA guidelines to find published research in international electronic databases (PubMed, Scopus, Web of Science) and Iranian local electronic databases (Iranian scientific information database [SID], Magiran, IranMedex) as well as in Google Scholar, without time limit and until January 1, 2025. To perform the analysis, the collected data were transferred to Stata version 18. Furthermore, health risk assessment was performed based on estimated daily intake (EDI) of AFB1 from wheat flour consumption, margin of exposure (MOE), and liver cancer risk in Iranian children and adults. In this meta-analysis, 10 studies with 735 wheat flour samples were considered for the final analysis. This analysis showed that the overall prevalence of AFB1 in Iranian wheat flour was 74.17% (95% CI: 57.50-90.84). Also, the pooled mean AFB1 concentration in Iranian wheat flour was 2.75 ng/g (95% CI: 1.94-3.56), which was lower than the maximum limit accepted by the Iranian National Standardization Organization (5 ng/g). This review showed that the mean EDI of AFB1 through wheat flour consumption for Iranian children and adults was 15 and 12 ng/kg bw/day, respectively. In addition, the mean MOE for children and adults was 11 and 14, respectively, indicating a public health concern. As well as, the current meta-analysis showed that the risk of liver cancer associated with wheat flour consumption among Iranian children and adults was 0.22 and 0.17 cancer cases/year/ per 105 people, respectively. According to the results of this study, although the pooled mean AFB1 concentration in Iranian wheat flour samples was within acceptable limits, there are public health concerns due to risk assessment findings. Therefore, continuous monitoring of aflatoxins in food is recommended for consumer safety.