A proposed method to determine fumonisin exposure from maize consumption in a rural South African population using a culturally appropriate FFQ.

ABSTRACT

OBJECTIVE: To develop an FFQ for estimating culture-specific maize intake that can distinguish between home-grown and commercial maize. Home-grown maize is more likely to be contaminated with fumonisins, mycotoxins that are associated with increased risk of oesophageal cancer. DESIGN: An existing FFQ developed for use in urban Xhosa populations was used as the initial framework for the maize-specific FFQ (M-FFQ). The existing questionnaire contained 126 food items divided into ten food groups (bread, cereals, vegetables, fruit, meat, dairy, snacks, condiments, beverages and fat). The M-FFQ was developed based on additional data obtained from a literature search, 24 h recalls (n 159), in-depth interviews (n 4), focus group discussions (n 56) and expert consultation. Food items available in local shops (n 3) were compared with information obtained from focus group discussions. SETTING: Five villages in two rural isiXhosa-speaking areas of the Eastern Cape Province, known to have a high incidence of oesophageal cancer, were randomly selected. SUBJECTS: Women aged 18-55 years were recruited by snowball sampling and invited to participate. RESULTS: The final M-FFQ comprised twenty-one maize-based food items, including traditional Xhosa dishes and beverages. The questionnaire focused on maize-specific dishes and distinguished between home-grown maize and commercial maize consumption. CONCLUSIONS: A culturally specific dietary assessment method was designed to determine maize consumption and therefore fumonisin exposure. The questionnaire will be tested against 24 h recalls and other methods to determine its validity, after which it will be used in various epidemiological studies to determine fumonisin exposure.