Type 2 diabetes is one of the major chronic diseases accounting for a substantial proportion of disease burden in Western countries. The majority of the burden of type 2 diabetes is attributed to environmental risks and modifiable risk factors such as lifestyle. The environment we live in, and changes to it, can thus contribute substantially to the prevention of type 2 diabetes at a population level. The ‘exposome’ represents the (measurable) totality of environmental, i.e. nongenetic, drivers of health and disease. The external exposome comprises aspects of the built environment, the social environment, the physico-chemical environment and the lifestyle/food environment. The internal exposome comprises measurements at the epigenetic, transcript, proteome, microbiome or metabolome level to study either the exposures directly, the imprints these exposures leave in the biological system, the potential of the body to combat environmental insults and/or the biology itself. In this review, we describe the evidence for environmental risk factors of type 2 diabetes, focusing on both the general external exposome and imprints of this on the internal exposome. Studies provided established associations of air pollution, residential noise and area-level socioeconomic deprivation with an increased risk of type 2 diabetes, while neighbourhood walkability and green space are consistently associated with a reduced risk of type 2 diabetes. There is little or inconsistent evidence on the contribution of the food environment, other aspects of the social environment and outdoor temperature. These environmental factors are thought to affect type 2 diabetes risk mainly through mechanisms incorporating lifestyle factors such as physical activity or diet, the microbiome, inflammation or chronic stress. To further assess causality of these associations, future studies should focus on investigating the longitudinal effects of our environment (and changes to it) in relation to type 2 diabetes risk and whether these associations are explained by these proposed mechanisms.

Graphical abstract

中文翻译：

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2型糖尿病的环境危险因素——一种暴露方法

2型糖尿病是主要慢性病之一，在西方国家占疾病负担的很大一部分。2 型糖尿病的大部分负担归因于环境风险和生活方式等可改变的风险因素。因此，我们生活的环境及其变化可以大大有助于在人群层面预防 2 型糖尿病。“暴露组”代表环境的（可测量的）整体，即非遗传因素，健康和疾病的驱动因素。外部暴露包括建筑环境、社会环境、物理化学环境和生活方式/饮食环境等方面。内部暴露组包括表观遗传、转录、蛋白质组、微生物组或代谢组水平的测量，以直接研究暴露，这些暴露在生物系统中留下的印记、身体对抗环境损害的潜力和/或生物本身。在这篇综述中，我们描述了 2 型糖尿病的环境危险因素的证据，重点关注一般的外部暴露体及其在内部暴露体上的印记。研究提供了空气污染、住宅噪音和地区社会经济剥夺与 2 型糖尿病风险增加的既定关联，而社区步行和绿地始终与 2 型糖尿病风险降低相关。关于食物环境、社会环境的其他方面和室外温度的贡献的证据很少或不一致。这些环境因素被认为主要通过结合生活方式因素的机制影响 2 型糖尿病风险，例如体育活动或饮食、微生物组、炎症或慢性压力。为了进一步评估这些关联的因果关系，未来的研究应侧重于调查我们的环境（及其变化）与 2 型糖尿病风险相关的纵向影响，以及这些关联是否可以通过这些提议的机制来解释。

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