University of Grenoble Alpes, French National Institute of Health and Medical Research, French National Center for Scientific Research, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute for Advanced Biosciences, Grenoble, France.
French National Institute of Health and Medical Research, Joint Research Unit 1018, Center for Research in Epidemiology and Population Health Integrative Respiratory Epidemiology Team, Villejuif, France.
Am J Respir Crit Care Med. 2022 Nov 15;206(10):1208-1219. doi: 10.1164/rccm.202205-0865OC.
Although previous studies in environmental epidemiology focused on single or a few exposures, a holistic approach combining multiple preventable risk factors is needed to tackle the etiology of multifactorial diseases such as asthma. To investigate the association between combined socioeconomic, external environment, early-life environment, and lifestyle-anthropometric factors and asthma phenotypes. A total of 20,833 adults from the French NutriNet-Santé cohort were included (mean age, 56.2 yr; SD, 13.2; 72% women). The validated asthma symptom score (continuous) and asthma control (never asthma, controlled asthma, and uncontrolled asthma) were considered. The exposome ( = 87 factors) covered four domains: socioeconomic, external environment, early-life environment, and lifestyle-anthropometric. Cluster-based analyses were performed within each exposome domain, and the identified profiles were studied in association to asthma outcomes in negative binomial (asthma symptom score) or multinomial logistic (asthma control) regression models. In total, 5,546 (27%) individuals had an asthma symptom score ⩾1, and 1,206 (6%) and 194 (1%) had controlled and uncontrolled asthma, respectively. Three early-life exposure profiles ("high passive smoking-own dogs," "poor birth parameters-daycare attendance-city center," or "⩾2 siblings-breastfed" compared with "farm-pet owner-molds-low passive smoking") and one lifestyle-anthropometric profile ("unhealthy diet-high smoking-overweight" compared with "healthy diet-nonsmoker-thin") were associated with more asthma symptoms and uncontrolled asthma. This large-scale exposome-based study revealed early-life and lifestyle exposure profiles that were at risk for asthma in adults. Our findings support the importance of multiinterventional programs for the primary and secondary prevention of asthma, including control of specific early-life risk factors and promotion of a healthy lifestyle in adulthood.
尽管以前的环境流行病学研究集中在单一或少数暴露因素上，但需要采用整体方法结合多种可预防的风险因素，以解决哮喘等多因素疾病的病因。本研究旨在调查社会经济、外部环境、生命早期环境和生活方式-人体测量因素的综合情况与哮喘表型之间的关联。共纳入了来自法国 NutriNet-Santé 队列的 20833 名成年人（平均年龄为 56.2 岁，标准差为 13.2，72%为女性）。考虑了经过验证的哮喘症状评分（连续变量）和哮喘控制情况（从未患有哮喘、控制良好的哮喘和控制不佳的哮喘）。暴露组（ = 87 个因素）涵盖了四个领域：社会经济、外部环境、生命早期环境和生活方式-人体测量。在每个暴露组领域内进行基于聚类的分析，并在负二项（哮喘症状评分）或多项逻辑回归（哮喘控制）回归模型中研究所识别的特征与哮喘结局之间的关联。共有 5546 名（27%）个体的哮喘症状评分 ⩾1，1206 名（6%）和 194 名（1%）个体分别患有控制良好的哮喘和控制不佳的哮喘。与“宠物农场-宠物主人-霉菌-低被动吸烟”相比，三种生命早期暴露特征（“高被动吸烟-自己的狗”、“较差的出生参数-日托出勤-市中心”或“⩾2 个兄弟姐妹-母乳喂养”）和一种生活方式-人体测量特征（“不健康的饮食-高吸烟-超重”与“健康的饮食-不吸烟-消瘦”）与更多的哮喘症状和控制不佳的哮喘相关。这项大规模的基于暴露组的研究揭示了与成年人哮喘相关的生命早期和生活方式暴露特征。我们的研究结果支持多干预计划在哮喘的一级和二级预防中的重要性，包括控制特定的生命早期风险因素和促进成年期的健康生活方式。
