{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T19:06:26Z","timestamp":1793387186804,"version":"4.5.0"},"reference-count":49,"publisher":"American Chemical Society (ACS)","issue":"11","license":[{"start":{"date-parts":[[2017,12,29]],"date-time":"2017-12-29T00:00:00Z","timestamp":1514505600000},"content-version":"vor","delay-in-days":3459,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2008,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cirrhosis of the liver is thought to be a major cause of morbidity and mortality in sub-Saharan Africa, but few controlled studies on the etiology of cirrhosis have been conducted in this region.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We aimed to elucidate the association between environmental and infectious exposures and cirrhosis in The Gambia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Ninety-seven individuals were diagnosed with cirrhosis using a validated ultrasound scoring system and were compared with 397 controls. Participants reported demographic and food frequency information. Blood samples were tested for hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), hepatitis C virus (HCV) antibody, HCV RNA, and the aflatoxin-associated 249ser TP53 mutation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>HBsAg seropositivity was associated with a significant increase in risk of cirrhosis [odds ratio (OR) = 8.0; 95% confidence interval (CI), 4.4\u201314.7] as was the presence of HBeAg (OR = 10.3; 95% CI, 2.0\u201353.9) and HCV infection (OR = 3.3; 95% CI, 1.2\u20139.5). We present novel data that exposure to aflatoxin, as assessed both by high lifetime groundnut (peanut) intake and by the presence of the 249ser TP53 mutation in plasma, is associated with a significant increase in the risk for cirrhosis (OR = 2.8; 95% CI, 1.1\u20137.7 and OR = 3.8; 95% CI, 1.5\u20139.6, respectively). Additionally, aflatoxin and hepatitis B virus exposure appeared to interact synergistically to substantially increase the risk of cirrhosis, although this was not statistically significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our results suggest that the spectrum of morbidity associated with aflatoxin exposure could include cirrhosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1289\/ehp.11661","type":"journal-article","created":{"date-parts":[[2008,7,10]],"date-time":"2008-07-10T15:15:50Z","timestamp":1215702950000},"page":"1553-1557","source":"Crossref","is-referenced-by-count":61,"title":["Aflatoxin Exposure and Viral Hepatitis in the Etiology of Liver Cirrhosis in The Gambia, West Africa"],"prefix":"10.1021","volume":"116","author":[{"given":"Mark H.","family":"Kuniholm","sequence":"first","affiliation":[{"name":"Infectious Disease Program, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olufunmilayo A.","family":"Lesi","sequence":"additional","affiliation":[{"name":"International Agency for Research on Cancer, Gambia Hepatitis Intervention Study, Banjul, The Gambia"},{"name":"Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maimuna","family":"Mendy","sequence":"additional","affiliation":[{"name":"Medical Research Council Laboratories, Banjul, The Gambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aliu O.","family":"Akano","sequence":"additional","affiliation":[{"name":"Department of Medical Services, Royal Victoria Teaching Hospital, Government of The Gambia, Banjul, The Gambia"},{"name":"Department of Radiodiagnosis, National Hospital, Abuja, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Sam","sequence":"additional","affiliation":[{"name":"Department of Medical Services, Royal Victoria Teaching Hospital, Government of The Gambia, Banjul, The Gambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Hall","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilton","family":"Whittle","sequence":"additional","affiliation":[{"name":"Medical Research Council Laboratories, Banjul, The Gambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ebrima","family":"Bah","sequence":"additional","affiliation":[{"name":"International Agency for Research on Cancer, Gambia Hepatitis Intervention Study, Banjul, The Gambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James J.","family":"Goedert","sequence":"additional","affiliation":[{"name":"Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Hainaut","sequence":"additional","affiliation":[{"name":"International Agency for Research on Cancer, Gambia Hepatitis Intervention Study, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory D.","family":"Kirk","sequence":"additional","affiliation":[{"name":"Infectious Disease Program, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"316","published-online":{"date-parts":[[2008,7,10]]},"reference":[{"key":"2026080313184198700_micit1","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1126\/science.8191284","article-title":"Geographic variation of p53 mutational profile in nonmalignant human liver","volume":"264","author":"Aguilar","year":"1994","journal-title":"Science"},{"key":"2026080313184198700_micit2","doi-asserted-by":"crossref","first-page":"8586","DOI":"10.1073\/pnas.90.18.8586","article-title":"Aflatoxin B1 induces the transversion of G \u2192 T in codon 249 of the p53 tumor suppressor gene in human hepatocytes","volume":"90","author":"Aguilar","year":"1993","journal-title":"Proc Natl Acad Sci USA"},{"key":"2026080313184198700_micit3","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1054\/bjoc.2001.1730","article-title":"Cancer in the Gambia: 1988\u20131997","volume":"84","author":"Bah","year":"2001","journal-title":"Br 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