"The Interplay Between Nutritional Deficiencies and Susceptibility to Mycotoxicosis: Implications for Public Health and Food Safety"

Abstract

Mycotoxins are pervasive contaminants of staple crops in tropical and subtropical regions and pose a persistent threat to food safety and public health, particularly among nutritionally vulnerable communities. This systematic review synthesizes evidence published between 2020 and 2025 on the bidirectional relationship between nutritional deficiencies and susceptibility to mycotoxicosis, integrating mechanistic, observational, and intervention studies to provide an integrated perspective. We searched PubMed, Scopus, and Web of Science and screened studies that examined nutrient status, absorption, detoxification, immune function, and health outcomes associated with aflatoxins, fumonisins, ochratoxins, trichothecenes, and zearalenone. Results identify several convergent mechanisms by which poor nutritional status amplifies mycotoxin harm. Protein energy deficiency and inadequate micronutrients such as vitamins A, C, E, folate, selenium, zinc, and iron impair hepatic Phase I and Phase II detoxification enzymes, reduce antioxidant defenses, and weaken immune competence. Conversely, common mycotoxins damage intestinal architecture and downregulate nutrient transporters, creating malabsorption syndromes that perpetuate nutrient loss. This reciprocal interaction generates a toxico nutritional spiral that is most evident among children, pregnant women, and immunocompromised adults in low income settings, with documented consequences including stunting, anemia, and adverse birth outcomes. The review highlights the predictive value of nutritional biomarkers such as serum retinol, selenium dependent glutathione peroxidase activity, plasma folate, serum zinc, and urinary oxidative damage markers to stratify vulnerability and monitor interventions. Evidence for mitigation supports integrated approaches combining agricultural measures to reduce contamination, biofortification, targeted micronutrient supplementation, improved post-harvest storage, culturally appropriate food processing, and gut focused strategies such as probiotics. While heterogeneity in study design limited meta-analysis, mechanistic findings from in vitro, animal, and human studies converge to justify context specific trials of combined nutrition and food safety interventions. We conclude that reducing the burden of mycotoxicosis requires coordinated multisectoral policies that link nutrition programs with crop management and surveillance, and research that advances biomarker validation, omics based mechanistic discovery, and scalable delivery models. Implementing these strategies can disrupt the toxico nutritional spiral, protect vulnerable populations, and strengthen food system resilience against a changing climate. Policy makers, researchers, and communities must collaborate to translate evidence into action.