The exposome concept refers to the totality of exposures from a variety of external and internal sources including chemical agents, biological agents, or radiation, from conception onward, over a complete lifetime. It encompasses also “psychosocial components” including the impact of social relations and socio-economic position on health. In this review we provide examples of recent contributions from exposome research, where we believe their application will be of the greatest value for moving forward. So far, environmental epidemiology has mainly focused on hard outcomes, such as mortality, disease exacerbation and hospitalizations. However, there are many subtle outcomes that can be related to environmental exposures, and investigations can be facilitated by an improved understanding of internal biomarkers of exposure and response, through the application of omic technologies. Second, though we have a wealth of studies on environmental pollutants, the assessment of causality is often difficult because of confounding, reverse causation and other uncertainties. Biomarkers and omic technologies may allow better causal attribution, for example using instrumental variables in triangulation, as we discuss here. Even more complex is the understanding of how social relationships (in particular socio-economic differences) influence health and imprint on the fundamental biology of the individual. The identification of molecular changes that are intermediate between social determinants and disease status is a way to fill the gap. Another field in which biomarkers and omics are relevant is the study of mixtures. Epidemiology often deals with complex mixtures (e.g. ambient air pollution, food, smoking) without fully disentangling the compositional complexity of the mixture, or with rudimentary approaches to reflect the overall effect of multiple exposures or components.

中文翻译：

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曝光组中有什么新内容？

暴露组概念是指从受孕开始，整个一生中各种外部和内部来源（包括化学制剂、生物制剂或辐射）的暴露总量。它还包含“社会心理成分”，包括社会关系和社会经济地位对健康的影响。在这篇综述中，我们提供了暴露组研究的最新贡献的例子，我们相信它们的应用将对未来的发展具有最大的价值。到目前为止，环境流行病学主要关注硬结果，例如死亡率、疾病恶化和住院治疗。然而，有许多微妙的结果可能与环境暴露有关，通过应用组学技术，更好地了解暴露和反应的内部生物标志物，可以促进调查。其次，尽管我们对环境污染物有大量的研究，但由于混杂、逆向因果关系和其他不确定性，因果关系的评估往往很困难。生物标志物和组学技术可以实现更好的因果归因，例如在三角测量中使用工具变量，正如我们在这里讨论的那样。更复杂的是对社会关系（特别是社会经济差异）如何影响健康以及对个人基本生物学的影响的理解。识别社会决定因素和疾病状态之间的分子变化是填补这一空白的一种方法。生物标志物和组学相关的另一个领域是混合物的研究。流行病学通常处理复杂的混合物（例如环境空气污染、食物、吸烟），而没有完全理清混合物的成分复杂性，或者使用基本方法来反映多重暴露或成分的总体影响。