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

Aflatoxin B (AFB), 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 via direct detection of AFB in the diet and serum AFB 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 in food samples and the level of serum AFB-albumin (AFB-Alb) adduct were quantitatively analyzed. Results showed that corn flour intake was positively associated with serum AFB-Alb adduct level ( for trend = 0.003), dietary AFB exposure ( for trend < 0.001), and the risk of EPL ( for trend = 0.017). Increased serum AFB-Alb adduct level was associated with an increased risk of EPL as well ( for trend < 0.001). In conclusion, corn flour may be an essential source of AFB in Huai'an District, whereas high exposure to AFB is likely to be an important risk factor contributing to the progression of EPL.