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If we date the origins of molecular epidemiology (defined as the reliance on tools of molecular biology in epidemiology, in particular, but not only, to assess exposures) to the publication, in 1993, of the book carrying this title,1 then this research field could be considered as having now reached the age of adulthood. While this young adult has some achievements already and has developed real strengths and recognition, many challenges lie ahead. The article by Lenters et al2 offers an opportunity to discuss one of the most promising challenges, namely, the one related to the application of the Exposome concept.
The Exposome concept
The Exposome encompasses lifetime environmental exposures from the prenatal period onwards.3 Although sometimes limited to exposures that can be assessed through biomarkers (the ‘internal Exposome)’, the Exposome should consider all exposures regardless of their most relevant mode of assessment, including lifestyle factors and factors assessed through questionnaires, environmental measurements and models. Consequently, this notion extends beyond the borders of molecular epidemiology. A first embodiment of the Exposome concept is the literature on biomonitoring, which provides a description of the levels of biomarkers of exposures to as many as several hundred environmental contaminants in population samples from some areas of the world, as illustrated in the National Health and Nutrition Examination Survey (NHANES) in the USA.4 This research vein can allow identifying patterns of co-varying exposures or behaviours, as is already carried out in dietary studies with the grouping of individuals sharing specific dietary patterns (eg, Mediterranean diet or fast-food type eating behaviours). It offers the perspective of identification of population subgroups simultaneously exposed to numerous adverse exposures, and of studying if these correlate with sociodemographic factors; to this extent, this research vein is connected to the issue of environmental equity,5 in which the focus is …
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