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Review, meta-analysis and carcinogenic risk assessment of aflatoxin M1 in different types of milks in Iran

  • Fatemeh Mortezazadeh and Fathollah Gholami-Borujeni EMAIL logo



Despite in recent decades, several studies on the concentration of aflatoxins M1(AFM1) in various milks have been studied, as we know, no systematic review, meta-analysis and carcinogenic risk assessment study was conducted in Iran till now.


In this study, a systematic review was conducted to collect, meta-analysis and carcinogenic risk assessment of the quantitative data regarding the prevalence and concentration of AFM1 in several types of milk produced in Iran.


In our study, the concentration and prevalence of AFM1 in different types of milk (Raw, pasteurized, and UHT) from 113 original articles in Iran using searching the Web of Science, PubMed, Scopus, Science Direct and Google Scholar (in Persian and English) databases from 2002 to august 2021 were collected. The concentration of AFM1 was meta-analyzed using the random effect model (REM) based on type of milk (raw, pasteurized and UHT) subgroups and Monte Carlo simulation (MCS) approach was used to assess safety risks and investigate carcinogenic effects of AFM1 using Crystal-Ball software (Version 11.1.3, Oracle, Inc., USA).

Summary and Outlook

The 113 original article (In English and Persian) were included in this review. Meta-analysis indicated lower and upper of AFM1 in subgroups of raw, pasteurized and UHT milk in Iran was 9, 720, 2.7, 230.2, 19.23, and 221.6 ng/kg respectively. The Point estimate for carcinogenic risk of AFM1 showed as result of age increasing, the carcinogenic risk of Aflatoxin M 1 decreases and concentration of Aflatoxin M1 (ng/liter), plays the most effective role in carcinogenic risk of AFM1.


The presence of AFM1 in milk and its products due to its high toxicity and carcinogenic properties is a public health concern that the results show that the risk of carcinogenesis is higher at younger ages (less than 20 years). As a result, there is a strong association between consumption of raw milk, pasteurized milk and UHT and the risk of cancer in children and adults in Iran.

Corresponding author: Fathollah Gholami-Borujeni, Associate Professor, Department of Environmental Health Engineering, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran, Phone: +989132802702, E-mail:


The authors thank to Student Research Committee of Deputy of Research and Technology of Mazandaran University of Medical Sciences for their financial support.

  1. Research funding: This research was supported by Deputy of Research and Technology of Mazandaran University of Medical Sciences (IR.MAZUMS.REC.1400.417).

  2. Author contributions: Fatemeh Mortezazadeh searched databases, screened results and extract data. She wrote the manuscript with support from Fathollah Gholami-Borujeni. Fathollah Gholami-Borujeni conceived of the presented idea, developed the theory, Meta-Analysis, risk assessment, and supervised the findings of this work. All authors discussed the results and contributed to the final manuscript.

  3. Competing interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

  4. Informed consent: Informed consent is not applicable.

  5. Ethical approval: The conducted research is not related to either human or animal use.


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Received: 2022-03-10
Accepted: 2022-05-16
Published Online: 2022-06-24
Published in Print: 2023-09-26

© 2022 Walter de Gruyter GmbH, Berlin/Boston

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