Multiple Aflatoxins Drive Cumulative Dietary Exposure and Hepatocellular Carcinoma Risk: An Age-Stratified Study in Guangzhou, China

Aflatoxins are widespread hepatotoxic food contaminants, yet age-specific cumulative exposure to multiple aflatoxins and associated health risks remain poorly characterized. This study assessed cumulative dietary exposure to aflatoxin B1 (AFB1), B2, G1, and G2, and hepatocellular carcinoma (HCC) risk across five age groups, evaluating the influence of packaging and retail sources on contamination. Contamination data of 1179 food samples and consumption data were integrated to calculate the margin of exposure (MoE) and annual HCC incidence. AFB1 was most frequently detected and often co-occurred with other aflatoxins; bulk vegetable oils showed the highest total aflatoxin detection rate. Roasted peanuts contributed most to aflatoxin exposure, particularly among children aged 3–6 (MoE 900–1206). Rice, rice products, and coarse grains were primary contributors to aflatoxin-attributable HCC risk (0.008 cases per 100,000 person-years). Overall contamination was significantly higher in bulk products than in pre-packaged foods (p < 0.05) and in samples from farmers’ markets and grocery stores than in other sites (p < 0.05). These findings reveal non-negligible aflatoxin-related health risks for Guangzhou residents, especially young children and frequent consumers of staple grains and nuts. Targeted monitoring of high-risk foods and retail environments and age-specific dietary guidance are recommended to reduce population-level aflatoxin exposure and HCC risk.