Prevalence and concentration of aflatoxin M1 and ochratoxin A in cheese: a global systematic review and meta-analysis and probabilistic risk assessment

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Abstract
Exposure to mycotoxins such as aflatoxins can endanger human health, especially infants and children. In this study, an attempt was made to retrieved studies related to the concentration of aflatoxin M1 (AFM1) and ochratoxin A (OTA). Search was performed in international databases such as Embase, PubMed, Scopus, and Web of Science for the period 1 January 2010 to 20 February 2023. Then, the pooled concentration in the defined subgroups was calculated using meta-analysis and the health risk assessment was conducted by margin of exposure (MOEs). Thirty-one scientific papers with 34 data reports (Sample size=2,277) were included in our study. The lowest and highest prevalence of AFM1 in cheese was related to El Salvador (12.18 %) and Serbia (100.00 %). The pooled prevalence of AFM1 was 49.85 %, 95 %CI (37.93–61.78 %). The lowest and highest prevalence of OTA in cheese was related to Türkiye (6.67 %) and Italy (44.21 %). The pooled prevalence of OTA was 35.64 %, 95 %CI (17.16–56.44 %). Health risk of AFM1 revealed that except Pakistan and Iran, MOE in the other countries was lower than 10,000 for adults and also except Pakistan, MOE for other countries was lower than 10,000 for children. Health risk of OTA revealed that except Greece, MOE in the other countries was higher than 10,000 for adults and also except Germany and Greece, MOE for other countries was higher than 10,000 for children. Therefore, it is recommended to conduct control plans to reduce the concentration of mycotoxins in cheese, especially AFM1.

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