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Aflatoxins are potent carcinogenic and immunomodulatory mycotoxins, and exposure may lead to deleterious effects on human health. This study aimed to detect aflatoxin M 1  (AFM 1 ) as biomarker of exposure and determine associated risk factors in children attending a specialized-childcare hospital in Lahore. Urine samples collected from 238 children (1–11 years) during winter (January–mid-March 2020) and hot-humid summer (August–September 2020) were tested for AFM 1  presence using ELISA. Data on potential risk factors were also collected. Of 238 samples, 156 (65.5%) were positive for urinary AFM 1 . Season was significantly associated (OR = 2.64; 95% CI = 1.49–4.79;  p  = 0.001) with AFM 1  positivity; prevalence was higher in hot-humid months (74.6%) than winter (57.3%). The place of living was also significantly associated (OR = 2.21; 95% CI = 1.25–3.97;  p  = 0.007), and urinary AFM 1  positivity was higher in urban children (71.1%) compared to rural (58.3%). Median value for creatinine-adjusted AFM 1  was 1.9 ng/mg creatinine (Q1–Q3 = 0.82–6.0 ng/mg creatinine), while non-creatinine-adjusted AFM 1  was 0.57 ng/mL (Q1–Q3 = 0.23–1.4 ng/mL). Significantly higher urinary AFM 1  levels were detected in children; age ≤2 years ( p  = 0.037), who consumed more milk ( p  = 0.048), and who presented to the nutrition clinic ( p  = 0.003). These findings highlight the need for an effective control program to reduce the AFM 1  burden in children.

Assessment of aflatoxin M 1 exposure and associated determinants in children from Lahore, Pakistan