Wang, Y.; Zhang, K.; Sun, Y.; Yang, L.; Yang, J.; Wang, X.; Wan, Y.; Xi, G.; Guo, L.; Sun, S.

Keshan disease (KD) and Kashin-Beck disease (KBD) are geographically restricted disorders in rural China with overlapping environmental and dietary risk factors. Selenium deficiency alone cannot explain their regional heterogeneity. Maize, a dietary staple in endemic areas, represents a key exposure pathway for climate-sensitive foodborne fungi and their metabolites. We profiled maize-associated fungal communities from seven villages across KD-, KBD-, KD-KBD co-endemic, and non-endemic regions using ITS sequencing and integrative bioinformatics. Fungal diversity, composition, trophic structure, and predicted biosynthetic gene cluster potential differed markedly among regions. KD-endemic areas were enriched in saprotrophic taxa such as Penicillium and Aspergillus, KBD-endemic regions favored cold- and humidity-adapted fungi, and KD-KBD co-endemic areas exhibited the highest predicted mycotoxin potential. Fungal patterns were strongly associated with regional temperature and humidity. These findings support a climate-sensitive, foodborne exposome framework, suggesting that variation in maize-associated fungi may contribute to endemic disease risk and highlighting the need for fungal surveillance in public health strategies.