The global status of aflatoxin M1 in cow milk 1990-2025: An assessment of occurrence and dietary exposure.

Aflatoxin B1 (AFB1), a carcinogenic mycotoxin in food and feed, is bio-transformed in the mammalian liver to aflatoxin M1 (AFM1), a potentially toxic metabolite excreted in cow milk. Hence, humans are exposed to AFM1 through dairy consumption. Despite its toxicity, numerous studies continue to report AFM1 occurrence levels (milk-borne concentrations) above the safety limits, indicating persistent exposure risks. A consolidated data set of global AFM1 occurrence levels spanning from 1990 to 2025, coupled with a data driven assessment of trends in AFM1 occurrence and exposure is not available in literature. Therefore, this study consolidated global reports of AFM1 occurrence in cow milk published from 1990 to 2025 and compared average occurrence and exposure levels for 1990-2010 versus 2011-2025. It also examined trends in scientific publications between the two periods, as reflected by publication volume, as well as developments in AFM1 quantification methods and their sensitivity. Scientific literature on AFM1 has increased worldwide over the past three decades, but geographic coverage remained limited. Among nations with data in both periods, most with concerning levels in 1990-2010 showed declines in 2011-2025. However recent reports in Ethiopia, Ghana, Kenya, Malawi, Nigeria, Tunisia, Rwanda, South Africa, Brazil, Colombia, Ecuador, Iran, Jordan, Pakistan, Syria, Yemen, Cyprus, Serbia, and Bangladesh indicated high occurrence, necessitating continued AFM1 control strategies. Trends in AFM1 exposure in the two time periods were governed predominantly by trends in AFM1 occurrence rather than milk consumption quantity. Ethiopia, Kenya, Rwanda, and Pakistan were identified as high-risk nations, due to high exposure and the presence of vulnerable populations. These insights help identify vulnerable populations and form targeted control strategies to minimize AFM1 dietary exposure.