Urinary mycotoxin levels in children with Crohn's disease: A pilot case–control study

Objective This pilot case–control study aimed to preliminarily explore the potential association between urinary levels of zearalenone and the risk of Crohn's disease in a pediatric cohort. Methods This pilot case–control study was conducted in China. The participants included 32 pediatric patients with newly diagnosed or relapsed Crohn's disease (cases) and 30 healthy controls. Urinary concentrations of zearalenone were quantified using a validated high-performance liquid chromatography–tandem mass spectrometry method. Data were analyzed using the Mann–Whitney U test for group comparisons, and receiver operating characteristic analysis was performed to evaluate the preliminary discriminatory performance of zearalenone. Results Urinary zearalenone concentrations were significantly higher in children with Crohn's disease than in healthy controls (median 0.33 vs. 0.16 pg/mL, p < 0.001). Receiver operating characteristic analysis yielded an area under the curve of 0.92 (95% confidence interval: 0.85–1.00) for zearalenone, indicating good exploratory discriminatory ability. Conclusions These exploratory findings suggest a preliminary link between elevated urinary zearalenone levels and pediatric Crohn's disease risk, potentially associated with its estrogenic properties. Given the pilot nature and limited sample size of this study, further large-scale longitudinal research is warranted to validate these observations and clarify the underlying biological mechanisms.