Aflatoxin M1 in Milk and Aflatoxin B1 in Animal Feed in Bangladesh: A Systematic Review, Meta-Analysis and Literature-Based Dietary Risk Assessment

Background: Aflatoxin M1 (AFM1), the carcinogenic metabolite of aflatoxin B1 (AFB1), passes into the milk of animals fed mould-contaminated feed. Bangladeshi feed and milk surveillance have developed separately, and integrated dietary-risk estimates are scarce. Objective and design: To pool AFM1 occurrence in Bangladeshi milk, summarise feed AFB1 and characterise age-stratified dietary risk. The assessment is literature-based and modular: no Bangladeshi study reports paired feed and milk data, so compartments are joined by parameter transfer. Methods: Prevalences were pooled by DerSimonian–Laird random-effects models with prediction intervals, subgroup, meta-regression, leave-one-out and small-study analyses. Exposure was modelled deterministically and probabilistically (100,000 iterations), with uncertainty tabulated following EFSA guidance. Results: Across 20 datasets (N = 605), pooled prevalence was 58.7% (95% CI 51.6%–65.5%; I2 = 61.9%; 95% prediction interval 32.1%–81.1%). Heterogeneity was structured by region (p = 0.001), not milk type (p = 0.980). The sample-weighted mean was 143 ng L−1 (geometric mean 92); 83% of milk exceeded the EU maximum level. Reconstruction from feed AFB1 predicted 24–282 ng L−1, containing 18 of 20 dataset means. Margins of exposure were 95 (infants) and 175 (toddlers), with probabilistic medians 157 and 286; the deterministic hazard index exceeded unity in every age group, the probabilistic median in every group except adults. Conclusions: Infant and child margins of exposure remain far below the 10,000 benchmark under every scenario and robustness check. The estimate is screening-level, resting on transferred parameters and ELISA-based measurement. Monsoon-aware feed management, enforcement of the national milk standard and paired feed–milk surveillance are indicated. © 2026 The Author(s). Veterinary Medicine and Science published by John Wiley & Sons Ltd.