Dietary exposure to aflatoxin B1 and ethanol from homemade and industrial fermented beverages in South Kivu, Democratic Republic of the Congo


  • Aladin Ombeni Mahano Department of Nutrition, High Institute of Public Health, Alexandria University, Egypt; Department of Pharmacy, Faculty of Pharmaceutical Sciences and Public Health, Université Officielle de Bukavu, D.R Congo
  • Neveen Fahmy Agamy Department of Nutrition, High Institute of Public Health, Alexandria University, Egypt
  • Doaa Tawfik Mohamed Department of Nutrition, High Institute of Public Health, Alexandria University, Egypt
  • Salma Adnan Bekhit Department of Environmental Health, High Institute of Public Health, Alexandria University, Egypt
  • Mahmoud Mohamed El Tawila Department of Nutrition, High Institute of Public Health, Alexandria University, Egypt



Aflatoxin B1, alcochol, exposure, Fermented beverage, South Kivu


BACKGROUND: The prevalence of AFB1 contamination in agricultural products used to produce fermented alcoholic beverages is increasing, raising concerns for human health.

AIM: The aim of this study was to investigate dietary exposure to AFB1 and ethanol through homemade and industrial fermented beverages commonly consumed in South Kivu, DR Congo.

METHOD: AFB1 and ethanol were measured using reverse-phase HPLC with a fluorescence detector and a refractive index detector, respectively. Data on fermented beverage consumption were collected from 847 adults using a food frequency questionnaire (FFQ).

RESULTS: The findings revealed that industrial sample Man 8 had the highest exposure to AFB1 (77.8 ± 45.0 ng/kg b.w/day) and Man4 had the highest ethanol exposure (4.83 ± 2.40 mg/kg b.w/day); while among homemade samples, Kasiksi had the highest exposure to both AFB1 (8.8 ± 6.6 ng/kg b.w/day) and ethanol (2.46 ± 1.85 mg/kg b.w/day). The margin of exposure (MOE) for AFB1 was 1011.7 or less, and for ethanol, it was 818.2 or less. Men are more likely to be exposed.

CONCLUSION: Increased consumption of homemade and industrial fermented beverages raises the risk of developing hepatocellular cancer (HCC) because the levels of AFB1 and ethanol MOE drop below the safe limit of 10000. Further research is needed to investigate the connection between AFB1, ethanol, and HCC, especially in regions where alcohol misuse is common.


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Arthur JW. Beer: A Global Journey through the Past and Present. Oxford: Oxford University Press; 2022. DOI:

WHO “World Health Organization.” Global Status Report on Alcohol and Health 2018. World Health Organization; 2018. P. 472. Available from: dle/10665/274603/9789241565639-eng.pdf

WHO “World Health Organization.” Global Status Report on Alcohol and Health 2018. World Health Organization; 2018. p. 450. Available from: uploads/sites/13/democratic-republic-congo-drinking-age.pdf

Eskola M, Kos G, Elliott CT, Hajšlová J, Mayar S, Eskola M. Worldwide contamination of food-crops with mycotoxins : Validity of the widely cited ‘ FAO estimate ’ of 25 %. Crit Rev Food Sci Nutr. 2020;60(16):2773-89. 408398.2019.1658570 PMid:31478403 DOI:

Udomkun P, Mutegi C, Wossen T, Atehnkeng J, Nabahungu NL, Njukwe E, et al. Occurrence of aflatoxin in agricultural produce from local markets in Burundi and Eastern Democratic Republic of Congo. Food Sci Nutr. 2018;6(8):2227-38. PMid:30510723 DOI:

Gloire KM, Imungi JK, Njue L. Aflatoxin contamination of maize meal sold and consumed in the three main cities of North-Kivu province of the Democratic Republic of Congo. J Exp Agric Int. 2019;40(6):1-6. DOI:

Kamika I, Ngbolua KN, Tekere M. Occurrence of aflatoxin contamination in maize throughout the supply chain in the Democratic Republic of Congo. Food Control. 2016;69:292-6. DOI:

Mahato DK, Lee KE, Kamle M, Devi S, Dewangan KN, Kumar P, et al. Aflatoxins in food and feed : An overview on prevalence, detection and control strategies. Food Microbiol. 2019;10:2266. PMid:31636616 DOI:

Marin S, Ramos AJ, Sanchis V. Mycotoxins : Occurrence, toxicology, and exposure assessment. Food Chem Toxicol. 2013;60:218-37. PMid:23907020 DOI:

WHO. Some Traditional Herbal Medicines, Some Mycotoxins, Naphthalene and Styrene. Vol. 82. Switzerland: World Health Organization; 2002. p. 601.

Liu Y, Wu F. Global burden of aflatoxin-induced hepatocellular carcinoma: A risk assessment. Environ Health Perspect. 2010;118(6):818-24. PMid:20172840 DOI:

Benford D, Leblanc JC, Setzer RW. Application of the margin of exposure (MoE) approach to substances in food that are genotoxic and carcinogenic Example : Aflatoxin B1 (AFB1). Food Chem Toxicol. 2010;48 Suppl 1:S34-41. PMid:20113853 DOI:

EFSA Panel on Contaminants in the Food Chain (CONTAM), Schrenk D, Bignami M, Bodin L, Chipman JK, Mazo JD, et al. Risk assessment of aflatoxins in food. EFSA J. 2020;18(3):e06040. PMid:32874256 DOI:

Tanaka T, Nishikawa A, Iwata H, Mori Y, Hara A, Hirono I, et al. Enhancing effect of ethanol on aflatoxin B1-induced hepatocarcinogenesis in male ACI/N rats. Jpn J Cancer Res. 1989;80(6):526-30. tb01671.x PMid:2474524 DOI:

Obidoa O, Okolo TC. Effect of ethanol administration on the metabolism of aflatoxin B1. Biochem Med. 1979;22(1):145-8. PMid:496928 DOI:

OCHA “United Nations Office for the Coordination of Humanitarian Affairs.” Health Zone of South-Kivu, DR Congo; 2014. p. 1. Available from: republic-congo/rd-congo-sud-kivu-carte-des-zones-de-sant-au- 29-avril-2014 [Last accessed on 2023 Jun 21].

UNDP “United Nations Development Programme.” Province du Sud Kivu : Profil Résumé, Pauvreté et Conditions de vie Des Ménages; 2009. Available from: files/zskgke326/files/migration/cd/undp-cd-profil-province-sud- kivu.pdf

Mahan LK, Raymond J. Intake: Analysis of the diet. In: Krause’s Food and the Nutrition Care Process. 14th ed. St. Louis, Missouri: Elsevier Inc.; 2017. p. 52-63. Available from: http://www.

Gibson RS. Anthropmetric assessment of body size. In: Principles of Nutritional Assessment. 2nd ed. New York: United States of America: Oxford University Press; 2005. p. 227-45. Available from: hl=fr&lr =&id=lblu7uki3aqc&oi=fnd&pg=pr11&dq=gibson,+r.s.+ (2005).+anthropmetric+assessment+of+body+size&ots= rwuwtnctle&sig=b2na3_wy1yn73na5ds4biy0s6xi&redir_ esc=y#v= onepage &q= gibson% 2cr.s

Moor JL. Analysis for aflatoxins in products containing alcohol. J Assoc Off Anal Chem. 1972;55(3):573. jaoac/55.3.573 DOI:

AOAC “Association of Official Analytical Chemists.” section 994.08: Natural contaminations. In: Cunniff P, editor. Official Methods of Analysis. 17th ed. Gaithersburg, Maryland: AOAC International; 2000.

Abdulra’uf LB, Ayeni KE, Ibraheem A, Ishaq A, Junaid AM, Aliu M, et al. Review of QuEChERS methods for the analysis of mycotoxins in food samples. In: Assaf JC, editor. Aflatoxins: Occurrence, Detection and Novel Detoxification Strategies. Rijeka: Intech Open; 2022. p. 30.

EC Commission Regulation (EC) No 401/2006: Laying down the methods of sampling and analysis for the official control of the levels of mycotoxins in foodstuffs. Off J Eur Union. 2006;70(12):12-34.

Schaarschmidt S. Public and private standards for dried culinary herbs and spices—part I: standards defining the physical and chemical product quality and safety. Food Control. 2016 Dec 1;70:339-49. DOI:

Dias GP, Cavalcante R, de Carvalho RC, de Souza CG, dos Santos AP, Andrade D, et al. Determination of methanol in gasoline and ethanol fuels by high-performance liquid chromatography. J Braz Chem Soc. 2020;31(5):1055-63. DOI:

Sharma VK, Jadhav RK, Rao GJ, Saraf AK, Chandra H. High performance liquid chromatographic determination of alcohols with reference to body distribution of methanol. Forensic Sci Int. 1991;50(2):255-61. PMid:1748360 DOI:

El Tawila MM, Al-Ansari AM, Alrasheedi AA, Neamatallah AA. Dietary exposure to acrylamide from cafeteria foods in Jeddah schools and associated risk assessment. J Sci Food Agric. 2017;97(13):4494-500. PMid:28294348 DOI:

EFSA. Opinion of the scientific panel on contaminants in the food chain on a request from the comission related to the potential increase of consumer health risk by a possible increase of the existing maximum levels for aflatoxins in almonds hazelnuts and. EFSA J. 2007;446:1-127. DOI:

Lachenmeier DW, Kanteres F, Rehm J. Epidemiology-based risk assessment using the benchmark dose/margin of exposure approach : The example of ethanol and liver cirrhosis. Int J Epidemiol. 2011;40(1):210-8. PMid:20819784 DOI:

Lachenmeier DW, Przybylski MC, Rehm J. Comparative risk assessment of carcinogens in alcoholic beverages using the margin of exposure approach. Int J Cancer. 2012;131(6):995- 1003. PMid:22447328 DOI:

Hazra A, Gogtay N. Biostatistics series module 3: Comparing groups: Numerical variables. Indian J Dermatol. 2016;61(3):251-60. PMid:27293244 DOI:

Lachenmeier DW, Leitz J, Schoeberl K, Kuballa T, Straub I, Rehm J. Quality of illegally and informally produced alcohol in Europe: Results from the AMPHORA project. Adicciones. 2011;23(2):133-40. PMid:21647540 DOI:

Bosch FX, Ribes J, Díaz M, Cléries R. Primary liver cancer: Worldwide incidence and trends. Gastroenterology. 2004;127(5 Suppl):S5-16. PMid:15508102 DOI:

Martinez P, Røislien J, Naidoo N, Clausen T. Alcohol abstinence and drinking among African women : Data from the World Health Surveys. BMC Public Health. 2011;11:160. PMid:21392398 DOI:

Bloomfield K, Gmel G, Neve R, Mustonen H. Investigating gender convergence in alcohol consumption in Finland, Germany, the Netherlands, and Switzerland : A repeated survey analysis Investigating Gender Convergence in Alcohol Consumption in Finland, Germany, The Netherlands, and Switzerland. Subst Abus. 2001;22(1):39-53. PMid:12466668 DOI:

Mancinelli R, Binetti R, Ceccanti M. Woman, alcohol and environment : Emerging risks for health. Neurosci Biobehav Rev. 2007;31(2):246-53. neubiorev.2006.06.017 PMid:16908064 DOI:

Rocha AR, Cardoso MS, Souza Júnior JA, Gomes Júnior EA, Maciel LF, Menezes-Filho JA. Occurrence of aflatoxins B1, B2, G1, and G2 in beers produced in Brazil and their carcinogenic risk evaluation. Food Control. 2023;145:109348. DOI:

Babor TF, Robaina K, Jernigan D. Vested interests in addiction research and policy the in fluence of industry actions on the availability of alcoholic beverages in the African region. Addiction. 2015;110(4):561-71. PMid:25510339 DOI:

Jernigan D, Noel J, Landon J, Thornton N, Lobstein T. Alcohol marketing and youth alcohol consumption : A systematic review of longitudinal studies published since 2008. Addiction. 2016;112 Suppl 1:7-20. PMid:27565582 DOI:

Donath C, Gräßel E, Baier D, Pfeiffer C, Karagülle D, Bleich S, et al. Alcohol consumption and binge drinking in adolescents: Comparison of different migration backgrounds and rural vs. urban residence - a representative study. BMC Public Health. 2011;11:84. PMid:21299841 DOI:

Mekuria AN, Routledge MN, Gong YY, Sisay M. Aflatoxins as a risk factor for liver cirrhosis : A systematic review and meta- analysis. BMC Pharmacol Toxicol. 2020;21(1):39. PMid:32487162 DOI:

Rawla P, Sunkara T, Muralidharan P, Raj JP. Update in global trends and aetiology of hepatocellular carcinoma. Wspolczesna Onkol. 2018;22(3):141-50. wo.2018.78941 PMid:30455585 DOI:

Chu YJ, Yang HI, Wu HC, Lee MH, Liu J, Wang LY, et al. Aflatoxin B(1) exposure increases the risk of hepatocellular carcinoma associated with hepatitis C virus infection or alcohol consumption. Eur J Cancer. 2018;94:37-46. PMid:29533866 DOI:

Wu HC, Santella R. The role of aflatoxins in hepatocellular carcinoma. Hepat Mon. 2012;12(10):8-16. https://doi. org/10.5812/hepatmon.7238 DOI:

Meijer N, Kleter G, de Nijs M, Rau M, Derkx R, van der Fels‐ Klerx HJ. The aflatoxin situation in Africa: Systematic literature review. Compr Rev Food Sci Food Saf. 2021;20(3):2286-304. PMid:33682354 DOI:

Burton R, Sheron N. No level of alcohol consumption improves health. Lancet. 2018;392(10152):987-8. DOI:

WHO “World Health Organization.” Unrecorded alcohol: What the evidence tells us. In: Snapshot Series on Alcohol Control Policies and Practice. World Health Organization; 2022. p. 1-32. Available from: dle/10665/352516/9789240044463-eng.pdf?sequence=1 [Last accessed on 2023 Jun 17].

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Mahano AO, Agamy NF, Mohamed DT, Bekhit SA, El Tawila MM. Dietary exposure to aflatoxin B1 and ethanol from homemade and industrial fermented beverages in South Kivu, Democratic Republic of the Congo. Open Access Maced J Med Sci [Internet]. 2024 Mar. 20 [cited 2024 Apr. 21];12:1-9. Available from:



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