A systematic literature review for aflatoxin M1 of various milk types in Iran: Human health risk assessment, uncertainty, and sensitivity analysis

Mycotoxins, especially aflatoxin M1 (AFM1), should be measured and monitored to ensure the safe consumption of dairy products. This study aims to determine the amount and evaluate the health risk of AFM1 in milk for different age groups in the last two decades in Iran through a systematic review. A systematic search was conducted to extract the required data from June 27, 2000, to October 10, 2022, and 72 papers were eventually chosen for this study based on the study selection criteria. Raw data from obtained studies was inaccessible, so Excel was used to re-simulate the data from each study. Then, from the simulated data, a statistical analysis, health risk assessment, uncertainty, and sensitivity analysis were conducted for the AFM1 of milk for adults and children. The overall average of AFM1 contamination in milk in Iran was 77 +/- 159 ng/kg, which is higher than the regulation of the European Union (EU = 50 ng/kg) and below the Institute of Standards and Industrial Research of Iran (ISIRI = 100 ng/kg). The ranking of milk types based on the average concentration of AFM1 was obtained as raw > ultra-high temperature processing (UHT) > pasteurized > government subsidizes milk (GSM) > mixed > sterilized. According to health risk assessment results, the milk produced in Iran in the last two decades in terms of AFM1 has potential carcinogenic and non-carcinogenic health risks. Therefore, it is necessary to pay special attention to continuous monitoring and control systems for milk produced throughout Iran. Due to the limited information regarding AFB1 in animal feeds, it would be important to carry out additional research in monitoring and preventing the dissemination of AFB1 in cattle fodder.