A 20-Year Data Review on the Occurrence of Aflatoxin M1 in Milk and Dairy Products in Mediterranean Countries—Current Situation and Exposure Risks

Aflatoxin M1 (AFM1) is a major carcinogenic compound found in milk and dairy products, posing a constant risk to consumers in the Mediterranean region. This study systematically reviewed AFM1 presence in these products in Mediterranean countries over a period of 20 years and estimated the relevant nutritional exposure for consumers. Using data from three databases, 596 articles were retrieved with 123 meeting the inclusion criteria. The frequency of AFM1 occurrence was 40% regardless of milk type, with non-cow milk showing an increasing trend. Moreover, the Estimated Daily Intake of AFM1 from milk and dairy product consumption and the associated Hazard Index were determined. Notably, Southeastern Mediterranean countries presented higher contamination levels, leading to elevated Estimated Daily Intake and Hhazard Index values. Thermally processed milk showed high contamination levels, and among dairy products, cheeses were the most contaminated. This review highlights AFM1 as a persistent hazard in the dairy sector, underscoring the need for effective interventions throughout the milk production stages.