The association between mycotoxin levels in urine of children and the risk of Crohn’s disease

Crohn’s disease (CD), a chronic inflammatory bowel disease with increasing pediatric incidence, is influenced by environmental factors, including potential dietary contaminants like mycotoxins. This study investigated the association between urinary levels of two mycotoxins, zearalenone (ZEN) and aflatoxin B1 (AFB1), and CD risk in children. In a case-control study involving 32 children with CD and 30 healthy controls, urinary ZEN and AFB1 concentrations were measured using high-performance liquid chromatography-tandem mass spectrometry. Urinary ZEN concentrations were significantly higher in CD cases compared to controls (median 0.33 pg/ml vs 0.16 pg/ml, P < 0.001), whereas no significant difference was observed for AFB1 levels (P = 0.989). Age-adjusted logistic regression analysis revealed a strong, dose-dependent positive association between higher urinary ZEN quartiles and CD risk; compared to the lowest 50%, adjusted Odds Ratios for the third and fourth quartiles of ZEN were 47.94 (P = 0.0001) and 62.93 (P = 0.0002), respectively. No significant association was found between urinary AFB1 levels and CD risk. Receiver Operating Characteristic analysis showed ZEN had superior discriminatory ability for CD (Area Under Curve [AUC] = 0.92) compared to AFB1 (AUC = 0.50). These findings demonstrate a strong positive association between elevated urinary ZEN levels and pediatric CD risk, suggesting ZEN exposure, potentially linked to its estrogenic properties, as an environmental risk factor. Conversely, urinary AFB1 was not associated with CD risk in this cohort, highlighting the potential role of specific mycotoxins in pediatric CD pathogenesis and warranting further investigation.