A national systematic literature review for aflatoxin M1 in commonly consumed cheese brands in Iran: Human health risk assessment by Monte Carlo simulation

Cheese is popular in Iran because of its high nutritional value; therefore, it is necessary to control this product regarding health risk factors, particularly aflatoxin M1 (AFM1). This research reviewed AFM1 in various varieties of cheese in Iran to assess the potential health risks associated with consuming these products for different age groups. In this regard, all accessible papers from different databases were screened between June 27, 2000 and October 10, 2022 b y systematic research and then considering the selection criteria of the studies; finally, 22 articles were selected for the current review. The amount and prevalence of AFM1 were calculated and separated based on the cheese variety, and the sampling location; health risk assessment (HRA), statistical, uncertainty, and sensitivity analysis for AFM1 of cheese for different age groups were performed. The study results for 2143 samples showed that the overall average AFM1 for cheese is 160 ± 175 ng/kg, below the European Commission (EC) regulation (250 ng/kg). AFM1 contaminated 72.42% of all cheese samples, and 13% of these contaminated samples had a higher AFM1 than the EC regulation. Cheese varieties were ranked based on average levels of AFM1 as white pasteurized > traditional > creamy > probiotic > Lighvan, and this ranking was obtained based on sampling locations as market > dairy factories > livestock farms. Based on the HRAs, from the perspective of the liver cancer risk (LCR), the margin of exposure (MOE), and the hazard index (HI) approach, it can be concluded that cheese produced in Iran, in terms of AFM1, particularly for children, poses serious health risks. Accordingly, it is imperative to carefully consider implementing suitable management methods to inhibit the growth of aflatoxin B1 (AFB1) in livestock fodder, and training in sanitary production and processing of dairy products according to world standards is suggested for industrial and traditional cheese producers across Iran.