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Toxic secondary metabolites of fungi frequently are present within the human food chain, including aflatoxins, from Aspergillus, and deoxynivalenol and fumonisins, from Fusarium. The heterogeneous contamination and the homogeneous diets in regions at greatest risk of exposure lead to chronic exposure at high levels in many developing countries. Developed regions of the world are also at risk from moderate chronic exposure to many mycotoxins. Mycotoxins are diverse in structure, but toxicities include effects on the immune system, growth, and cancer. The use of aflatoxin biomarkers to improve exposure assessment has been critical in understanding the molecular epidemiology of chronic disease, and their use continues to be of importance in understanding novel disease aetiology. Exposure biomarkers for Fusarium mycotoxins are in their infancy by comparison, though the next decade will lead to their application in epidemiological studies. All of the exposure biomarkers will be utilized to assess the efficacy of intervention studies, and to assess the potential synergy or confounding of co-exposures. The overall disease burden from mycotoxins remains unknown, but understanding the extent of the problem through molecular epidemiological approaches and interventions is likely to support the health of many millions of individuals.

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