Mycotoxins have been investigated in relation to a wide range of adverse human health effects, but the evidence for all but a small number of associations is limited. Thus, the full impact on human health of the widespread exposure to
mycotoxins remains to be defined. The main exception is for
aflatoxins; epidemiological, experimental, and mechanistic studies have contributed to establishing
aflatoxins as a cause of human
liver cancer, with a particularly elevated risk in people chronically infected with hepatitis B virus. In addition, acute
aflatoxicosis after exposure to high dietary toxin levels has been demonstrated. The impairment of child growth by
aflatoxin exposure early in life remains an important subject of study. More information is also required on the potential immune effects of
aflatoxins, especially in vulnerable populations. For
fumonisins, studies indicate a possible role in oesophageal
cancer and in
neural tube defects, although no definitive conclusions can be drawn at present. For
deoxynivalenol and other
trichothecenes, exposure has been linked to acute
poisoning outbreaks in large numbers of subjects. For
ochratoxin A and
zearalenone, the human health effects remain undefined. The limited tools available to accurately assess human exposure to
mycotoxins and the relative paucity of epidemiological studies need to be addressed if the full extent of the adverse effects of these common dietary contaminants is to be understood and adequate public health measures taken. In this respect, newly established
biomarkers of exposure at the individual level are proving valuable in improving exposure assessment in epidemiological studies.