MRC Centre for Environment and Health, School of Public Health, Imperial College London, United Kingdom.
Université de Paris, INSERM U 1124 (T3S), Paris, France.
Environ Int. 2022 Jul;165:107312. doi: 10.1016/j.envint.2022.107312. Epub 2022 May 21.
The understanding of disease etiology and pathogenesis has radically changed as a consequence of the new challenges posed by climate change, environmental degradation and emerging infectious diseases. The awareness of the influence of distal causes (e.g. planetary changes at the roots of new pandemics), of the social environment and of early life exposures calls for innovative models of disease onset. Here we propose a scheme for the practice of epidemiology and toxicology that incorporates new recent advancements in both disciplines, under the general umbrella of the "exposome". The exposome approach to disease encompasses a lifecourse perspective from conception onwards, and the investigation of the role played by all exposures individuals undergo in their lives. These include social inequalities and psychosocial influences, in addition to chemical, biological and physical exposures. We stress the role played by social differences and inequalities in the course of life as an overarching factor that influences downstream layers (including behaviours). We show that the idea of "lifecourse exposome" is compatible with the current interpretation of Adverse Outcome Pathways in toxicology, and in fact we propose an extension of the concept towards "lifecourse Adverse Outcome Pathways". We propose to merge different research perspectives and promote an encounter between the sociological perspective of "biography" (using Pierre Bourdieu's conceptual framework) and biology, according to the idea of accumulated biological capital of individuals. We also propose to treat social capital (including inequalities) no longer as a confounding factor but as an overarching determinant, perhaps the most important of all because it is the one that influences all other exposures downstream. The importance of early exposures in a lifecourse perspective leads to policy implications, i.e. investing more in the various forms of capital (social, economic, cultural) in early life.
由于气候变化、环境恶化和新发传染病带来的新挑战，对疾病病因和发病机制的认识发生了根本性的变化。人们意识到远程病因（例如，新大流行病根源的行星变化）、社会环境和早期生活暴露的影响，这就需要创新的疾病发病模式。在这里，我们提出了一个将流行病学和毒理学的新进展纳入其中的实践方案，该方案涵盖了“暴露组学”的一般范围。暴露组学方法涵盖了从受孕开始的整个生命过程，并研究了个体在其一生中所经历的所有暴露的作用。这些包括社会不平等和心理社会影响，以及化学、生物和物理暴露。我们强调了社会差异和不平等在生命过程中所扮演的角色，作为一个影响下游层（包括行为）的总体因素。我们表明，“生命过程暴露组学”的概念与毒理学中当前对不良结局途径的解释是一致的，事实上，我们提出了将该概念扩展到“生命过程不良结局途径”。我们建议合并不同的研究视角，并根据个体累积生物资本的理念，促进“传记”的社会学视角（使用皮埃尔·布迪厄的概念框架）与生物学之间的相遇。我们还建议不再将社会资本（包括不平等）视为混杂因素，而是将其作为一个总体决定因素，也许是最重要的因素，因为它影响着下游的所有其他暴露。生命过程视角下的早期暴露的重要性导致了政策上的影响，即在生命早期更多地投资于各种形式的资本（社会、经济、文化）。
