Knowledge, attitude and practice of Aflatoxin contamination, factors associated with Aflatoxin biomarkers and their reduction using probiotic among healthy Malaysian adults

Limited evidence exists on aflatoxin exposure among Malaysians and the effect of probiotic Lacticaseibacillus paracasei strain Shirota (LcS) in reducing aflatoxin levels. This study had two phases. Phase 1 screened 359 healthy non-obese Malaysian adults (aged 20−60 years) to assess the factors associated with knowledge, attitude, and practice (KAP) towards aflatoxin contamination. Data on sociodemographic characteristics and KAP were collected via self-administered questionnaire, alongside body weight and height measurements. Majority of the respondents were female, aged 25−44 years, Chinese, unmarried, with tertiary education, employed, had household income of RM 5,001−10,000, and had a BMI of 14.1−24.9 kg/m2. Although 49.0% of respondents had poor knowledge, most of them had positive attitudes (57.4%) and acceptable practices (78.8%) towards controlling aflatoxin contamination. Gender, occupation, monthly household income, and body weight status predicted knowledge score, whereas education predicted attitude and practice scores. Phase 2 involved a randomized, double-blind, placebo-controlled intervention that investigated the factors associated aflatoxin levels and their reduction by probiotic LcS. Subjects were screened for urinary AFM1, with those above or at the 25th percentile screened for serum AFB1-albumin. Only subjects with serum AFB1-albumin level at or above the 25th percentile or above were enrolled in the intervention. About 174 eligible subjects were randomly assigned in equal numbers to intervention (probiotic drink containing LcS) and control (milk drink without LcS) groups. The intervention ran for 12 weeks, with a 4-week post-intervention. First morning urine samples, body weight, dietary intake, and physical activity were collected every two weeks while fasting blood samples were taken every four weeks for 16 weeks. Morning urine and fasting blood samples were collected for urinary AFM1 and serum AFB1-lysine adduct analyses, respectively. Baseline data from the second phase showed that most subjects were females, aged 20−29 years, Chinese, single/divorced, with tertiary education, living in households with 4−6 members, had monthly household income of RM 4,851 – RM 10,970, and exhibited poor knowledge, positive attitude, and moderate practice towards aflatoxin contamination. Aflatoxin levels significantly varied across ethnicity (p<0.05). Knowledge level was negatively associated with serum AFB1-lysine adduct level (p=0.04). Urinary AFM1 level increased with cereal intake (p=0.03) but decreased with protein intake (p=0.02). Urinary AFM1 level was suppressed by 77% in the Probiotic group compared with the Placebo group (p=0.04). Although not significant, a consistent decrease in the serum AFB1-lysine adduct level was observed through the LcS consumption at all time points. In summary, Phase 1 revealed that females, the unemployed, individuals with underweight/normal weight, and households earning >RM 10,000 monthly exhibited higher knowledge levels regarding aflatoxin. Tertiary education correlated with elevated attitude and practice scores. Phase 2 demonstrated that ethnicity, knowledge level, as well as cereal and protein intake, influenced aflatoxin exposure. LcS effectively reduced urinary AFM1 levels compared to placebo among healthy Malaysian adults, suggesting its potential for inclusion in public health strategies. Encouraging sustained use of LcS for at least 12 weeks could significantly lower aflatoxin levels. Further research is needed to explore the long-term effects of probiotic consumption for sustained reduction in aflatoxin levels.

Text FPSK (p) 2024 21 - Declaration Form.pdf Restricted to Repository staff only Available under License Creative Commons Attribution Non-commercial No Derivatives. Download (468kB) Text FPSK (p) 2024 21 - Full Text.pdf Available under License Creative Commons Attribution Non-commercial No Derivatives. Download (14MB) Text FPSK (p) 2024 21.pdf Restricted to Repository staff only Available under License Creative Commons Attribution Non-commercial No Derivatives. Download (14MB)

Actions (login required)

View Item