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Aflatoxin B 1  is an important toxic food contaminant and there is very little information available about its exposure and effects on the health of the Pakistani population. Therefore, children ( n  = 238) aged 1–11 years were recruited in this study to estimate the levels of aflatoxin B 1 -lysine adduct and to measure its adverse effects on growth. Blood samples were analyzed to detect AFB 1 -lysine adducts through high-performance liquid chromatography. Socio-demographic information and anthropometry measurements were also obtained. All participants had detectable levels of AFB 1 -lysine adduct with a median concentration of 10.66 pg/mg albumin (95% CI: 8.6–12.4). Differences in area of residence ( p  &lt; 0.05) and the father’s employment ( p  &lt; 0.05) were significant predictors for aflatoxin concentration levels in ordinary least square and quantile regression models (residence in 75th quantile and father employment in 90th quantile). Children aged from 5 to 11 years in the 5th and 90th quantiles of the regression model had a significant association with aflatoxin levels. A very high (50.4%, 120/238) prevalence of growth impairment (stunting, wasting, and underweight) was also observed in this study. Although we couldn’t establish the effect of aflatoxin on growth impairment, children with low serum albumin levels (OR = 0.18; 95% CI: 0.05–0.56;  p  = 0.004) were likely to be at risk of wasting. Also, low birth weight was strongly associated with wasting (OR = 3.11; 95% CI: 1.36–7.03;  p  = 0.006) and underweight (OR = 4.60; 95% CI: 2.21–10.05;  p = &lt;0.001), while the mother’s school level education had a correlation with child stunting (OR = 1.84; 95% CI: 1.07–3.22;  p  = 0.029). The high prevalence of growth impairment and high concentration of serum AFB 1 -lysine adduct levels in study participants demand immediate efforts to mitigate the adverse health outcomes in children in Pakistan.

Assessment of aflatoxin B 1 -lysine adduct in children and its effect on child growth in Lahore, Pakistan