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Exposição a micotoxinas : os desafios da avaliação de impacto na saúde
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Resumo - Introdução: As micotoxinas, principalmente a aflatoxina B1, são contaminantes químicos alimentares relevantes em termos de toxicidade, apresentando diversos efeitos para a saúde, sendo uma preocupação numa perspetiva da saúde pública. Este estudo teve como objetivo avaliar o impacto em saúde decorrente da exposição humana a micotoxinas. Métodos: Realizou-se uma pesquisa bibliográfica para obter dados sobre a ocorrência em alimentos, a exposição humana às micotoxinas e o impacto na saúde, identificando as lacunas existentes na evidência científica disponível. Elaborou-se um estudo de caso para analisar o impacto da exposição a aflatoxinas associada ao consumo de produtos à base de amendoim no Brasil, avaliado pelo desenvolvimento de carcinoma hepatocelular (CHC) e estimativa do número de anos de vida ajustados por incapacidade (DALY). Resultados: Foram analisadas 18 referências bibliográficas e foram resumidas as incertezas e limitações. A média do número de casos de CHC estimados foi de 0,0008 para adolescentes, para adultos 0,0003, para idosos, 0,0005, para homens 0,0005 e para mulheres 0,0005 casos por 100.000 indivíduos. Em média foram estimados 0,004 DALY, 0,002 DALY, 0,002 DALY, 0,003 DALY e 0,05 DALY por 100.000 habitantes, para os mesmos grupos, respetivamente. Conclusões: O presente estudo permitiu identificar as limitações que contribuem para as incertezas na avaliação de impacto em saúde. Apesar de o impacto em saúde resultante do estudo de caso ser reduzido, é importante que existam estratégias de controlo de contaminação por aflatoxinas e sejam reforçadas continuamente como medida de prevenção de doença e promoção da saúde.
Abstract - Introduction: Mycotoxins, mainly aflatoxin B1, are among the most relevant chemical contaminants in terms of toxicity, causing several health effects and being a concern from a public health perspective. This study aimed to evaluate the health impact of human exposure to mycotoxins. Methods: A review was carried out to obtain data about their occurrence in food, human exposure to mycotoxins and their impact on health, identifying gaps in the available scientific evidence. A case study was designed to analyze the impact of exposure to aflatoxins associated with the consumption of peanut products in Brazil, assessed by the development of hepatocellular carcinoma (HCC) and estimation of the number of disability-adjusted life years (DALY). Results: 18 references were included in this review and the uncertainties and limitations were summarized. The average number of estimated HCC cases was 0.0008 for adolescents, for adults 0.0003, for the elderly 0.0005, for men 0.0005 and for women 0.0005 cases per 100,000 individuals. On average, 0.004 DALY, 0.002 DALY, 0.002 DALY, 0.003 DALY and 0.05 DALY per 100,000 inhabitants were estimated for the same groups, respectively. Conclusions: The present study made possible to identify the limitations that are relevant to the uncertainties in health impact assessment. Although the health impact resulting from the case study was reduced, it is important that strategies exist to control aflatoxins contamination and are continually reinforced as a measure to prevent disease and promote health.
Abstract - Introduction: Mycotoxins, mainly aflatoxin B1, are among the most relevant chemical contaminants in terms of toxicity, causing several health effects and being a concern from a public health perspective. This study aimed to evaluate the health impact of human exposure to mycotoxins. Methods: A review was carried out to obtain data about their occurrence in food, human exposure to mycotoxins and their impact on health, identifying gaps in the available scientific evidence. A case study was designed to analyze the impact of exposure to aflatoxins associated with the consumption of peanut products in Brazil, assessed by the development of hepatocellular carcinoma (HCC) and estimation of the number of disability-adjusted life years (DALY). Results: 18 references were included in this review and the uncertainties and limitations were summarized. The average number of estimated HCC cases was 0.0008 for adolescents, for adults 0.0003, for the elderly 0.0005, for men 0.0005 and for women 0.0005 cases per 100,000 individuals. On average, 0.004 DALY, 0.002 DALY, 0.002 DALY, 0.003 DALY and 0.05 DALY per 100,000 inhabitants were estimated for the same groups, respectively. Conclusions: The present study made possible to identify the limitations that are relevant to the uncertainties in health impact assessment. Although the health impact resulting from the case study was reduced, it is important that strategies exist to control aflatoxins contamination and are continually reinforced as a measure to prevent disease and promote health.
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micotoxinas aflatoxinas carcinoma hepatocelular DALYs avaliação do risco mycotoxins aflatoxins hepatocellular carcinoma risk assessment