INTRODUCTION Lifelong adherence to a gluten-free diet (GFD) is the primary treatment of celiac disease (CeD), a gluten-driven enteropathy. Concerns have been raised about increased exposure to arsenic from a GFD because rice, which naturally bioaccumulates arsenic, is commonly used as a substitute for gluten-containing grains such as wheat. We hypothesize that arsenic exposure increases in newly diagnosed children with CeD after they adopt a GFD. METHODS This is a single-center prospective longitudinal cohort study of children (age 2-18 years) with elevated celiac serology who underwent a diagnostic endoscopy before initiation of a GFD between January and May 2022. The primary outcome was change in urinary arsenic concentration between endoscopy and after 6 months on a GFD. RESULTS Of the 67 recruited participants, 50 had a biopsy diagnostic of CeD and were invited to continue the study. Thirty-five participants completed sample collection. Participants were from a middle-class, well-educated population that was predominantly White with presenting symptoms of abdominal pain (51%) and diarrhea (29%). After 6 months on a GFD, there was a significant increase in the median urinary arsenic concentration (3.3 µg/L vs 13.6 µg/L, P = 0.000004). In regression models, family history of CeD and Hispanic ethnicity were associated with having a higher urinary arsenic concentration after 6 months on a GFD. DISCUSSION Children with newly diagnosed CeD have increased arsenic exposure shortly after transitioning to a GFD. While the arsenic levels were well below acutely toxic concentrations, the clinical impact of chronic exposure to mildly elevated arsenic levels is unknown.

中文翻译：

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采用无麸质饮食对乳糜泻儿童砷和其他重金属暴露的影响：一项前瞻性队列研究。


引言 终身坚持无麸质饮食 （GFD） 是乳糜泻 （CeD） 的主要治疗方法，乳糜泻是一种麸质驱动的肠病。人们担心 GFD 会增加砷的暴露量，因为大米自然生物积累砷，通常用作小麦等含麸质谷物的替代品。我们假设新诊断的 CeD 儿童在采用 GFD 后砷暴露量会增加。方法 这是一项单中心前瞻性纵向队列研究，研究对象为乳糜泻血清学升高的儿童（2-18 岁），这些儿童在 2022 年 1 月至 5 月期间开始 GFD 之前接受了诊断性内窥镜检查。主要结局是内窥镜检查之间和 GFD 治疗 6 个月后尿砷浓度的变化。结果 在 67 名招募的参与者中，50 名经活检诊断为 CeD，并被邀请继续研究。35 名参与者完成了样本采集。参与者来自受过良好教育的中产阶级人群，其中主要是白人，表现为腹痛 （51%） 和腹泻 （29%）。GFD 治疗 6 个月后，尿砷浓度中位数显著增加 （3.3 μg/L vs 13.6 μg/L，P = 0.000004）。在回归模型中，CeD 家族史和西班牙裔与 GFD 6 个月后尿砷浓度较高相关。讨论 新诊断的 CeD 儿童在过渡到 GFD 后不久砷暴露量增加。虽然砷水平远低于急性毒性浓度，但长期暴露于轻度升高的砷水平的临床影响尚不清楚。