Gluten-free pasta: a possible risk for toddlers?

Celiac disease in the Campania Region has an incidence of about 7.3 cases per 100,000 inhabitants in the adult population and 27.4 cases in the smaller population of children. Celiac disease is an autoimmune disorder that is based on a genetic predisposition and an external triggering factor represented by the high molecular weight proteins constituting gluten. Various food products such as wheat, rye, barley etc. contain gluten that is sometimes present in foods that are only apparently free. The national prevalence of celiac disease ranges from 0.5 percent to 1 percent of the population or about 500,000 Italians, and at present, the most effective treatment is to eliminate gluten from the diet.

The Food Chemistry group of the Federiciano Department of Pharmacy, coordinated by Professor Alberto Ritieni as part of a research project carried out as part of the International Doctoral Program in Nutraceuticals, Functional Foods and Human Health, analyzed 84 samples of dry pasta marketed in Campania and destined for the gluten-free market to quantify the levels of 21 different mycotoxins. The work was published in Toxins and can be retrieved from the following link.

The study used a Q-Exactive high-resolution mass spectrometer and optimization of a suitably implemented method for food matrices testing for gluten. Ninety-five percent of the samples were found to be contaminated with one or more mycotoxins, with fumonisin B1 (FB1), zearalenone (ZON) and deoxynivalenol (DON) being the most frequent. The observed levels ranged between 182 and 377 ppb for DON, between 9.0 and 26.9 ppb for ZON, and between 39.9 and 246.9 ppb for FB1. In addition, 9% of the samples were contaminated with a single mycotoxin, double contamination was observed in 11%, while in 44% of the samples analyzed, there was co-presence of at least 3 different mycotoxins.

The main objective of the study was to determine the actual exposure to mycotoxins possibly present in gluten-free products in the various age groups of consumers with celiac disease, quantifying the risk related to the consumption of products made from rice, corn, etc. that are used since childhood in cases of early diagnosis. The data collected show that the PDT (Probable Daily Dose) value is always lower than the TDI (Tolerable Daily Dose). The exception is the group of children between the ages of 3 and 10 years who are exposed, through diet, to values above the allowable TDI for both DON and nivalenol. The higher risk for the younger age group of consumers is not surprising considering that their consumption of pasta is proportionately higher due to their lower body weight than the other age groups of consumers.

This study considered only the consumption of dry gluten-free pasta and its relative weight in the risk of exposure to the 21 mycotoxins without evaluating additional sources of hazard for the same or other mycotoxins. A fascinating hypothesis, supported by multiple scientific studies on DON interference with the tight junctions of intestinal mucosal cells, makes DON similar to a'Trojan horse' that, unintentionally opens a gateway for gluten to enter the intestinal mucosa. This hypothesis would make DON present in celiac products, similar to a trigger for the development of celiac disease, naturally, in those who are genetically predisposed.