Date of Award

Fall 2022

Project Type

Thesis

Program or Major

Nursing

Degree Name

Master of Science

First Advisor

Pamela DiNapoli

Second Advisor

Pamela DiNapoli

Third Advisor

Cathleen C Colleran

Abstract

AbstractBACKGROUND: The incidence of pediatric Crohn’s disease (CD) has increased over the past few decades. The etiology of CD has not yet been elucidated. Still, researchers have identified variables associated with the disease process, including genetic predisposition, environmental triggers like a poor-quality diet, air pollution, water pollution, and a dysbiotic microbiome with increased fungal diversity as predisposing factors. Fungal mycotoxin contamination in the food supply from toxicants like Deoxynivalenol (DON), a highly prevalent gastrointestinal irritant, has largely been ignored as a potential factor influencing the fungal dysbiosis and symptoms associated with the disease process. It is hypothesized that global and intermittent exposure to mycotoxins like DON may negatively affect the gastrointestinal health of pediatric CD patients. OBJECTIVE: The objective of this two-part project was to: 1) Gather evidence of mycotoxin contamination in the food supply, 2) Given the evidence then, to test local food commodities for mycotoxins for the development of a low-mycotoxin diet as a potential treatment modality for pediatric CD. METHODS: An integrative review of studies measuring global DON prevalence was conducted. With evidence that wheat and corn crops are routinely contaminated with mycotoxins, flours containing these ingredients were directly tested for DON using lateral flow screening technology. Wheat bread and pasta samples were also analyzed and sent to Trilogy laboratory for liquid chromatography, mass spectrometry-mass spectrometry mycotoxin testing. RESULTS: Results of the integrative review showed that globally, wheat, corn, bakery products, pasta, and mothers’ milk were routinely contaminated with DON. There was also sufficient evidence to suggest that other grain-based crops, soy, coffee, tea, dried spices, nuts, certain seed oils, animal milk, and various water reservoirs are intermittently contaminated. The direct measurement of foods in a typical child’s diet, such as pasta, bread, and raw ingredients such as wheat- and corn-based flours, also demonstrated routine contamination with DON. Some pasta samples were also contaminated with HT-2 toxin. Contamination rates were significantly higher in 2021 than in 2019, showing the problem may be escalating. DISCUSSION AND CONCLUSIONS: Universally, due to their increased intake of cereal-based foods relative to their lower body weight it would appear children are at higher risk for exposures to DON than adults. A review of the literature suggests that mycotoxin contamination in the food supply is common. The cumulative effects of multiple mycotoxin exposures by pediatric CD patients may pose serious health risks. Further investigation into the role mycotoxin contamination plays in the disease process, microbial perturbations, and fungal dysbiosis inherent in CD is needed. The information obtained here demonstrates a need to develop a “Low Mycotoxin Diet” for pediatric CD patients to help mitigate the common occurrence of these biohazards.

Download

Share

COinS