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Aflatoxin B 1 (AFB 1 ), which has potent toxicity and carcinogenicity, is a common contaminant of important agricultural commodities. This study aimed to investigate the frequency of corn flour intake and assess the exposure to AFB 1 via direct detection of AFB 1 in the diet and serum AFB 1 exposure biomarker, so as to evaluate their associations with the risk of esophageal precancerous lesions (EPL). A case-control study based on three-day duplicate diet samples was performed in Huai'an District. One hundred EPL cases and 100 healthy controls were enrolled and required to be age- (±2 years) and gender-matched. The concentration of AFB 1 in food samples and the level of serum AFB 1 -albumin (AFB 1 -Alb) adduct were quantitatively analyzed. Results showed that corn flour intake was positively associated with serum AFB 1 -Alb adduct level ( p for trend = 0.003), dietary AFB 1 exposure ( p for trend &lt; 0.001), and the risk of EPL ( p for trend = 0.017). Increased serum AFB 1 -Alb adduct level was associated with an increased risk of EPL as well ( p for trend &lt; 0.001). In conclusion, corn flour may be an essential source of AFB 1 in Huai'an District, whereas high exposure to AFB 1 is likely to be an important risk factor contributing to the progression of EPL.

Corn Flour Intake, Aflatoxin B1 Exposure, and Risk of Esophageal Precancerous Lesions in a High-Risk Area of Huai’an, China: A Case-Control Study