TY - JOUR
T1 - Environmental risk factors of type 2 diabetes—an exposome approach
AU - Beulens, Joline W. J.
AU - Pinho, Maria G. M.
AU - Abreu, Taymara C.
AU - den Braver, Nicole R.
AU - Lam, Thao M.
AU - Huss, Anke
AU - Vlaanderen, Jelle
AU - Sonnenschein, Tabea
AU - Siddiqui, Noreen Z.
AU - Yuan, Zhendong
AU - Kerckhoffs, Jules
AU - Zhernakova, Alexandra
AU - Brandao Gois, Milla F.
AU - Vermeulen, Roel C. H.
N1 - Funding Information: Work in the authors’ laboratories is supported by EXPOSOME-NL and EXPANSE. EXPOSOME-NL is funded through the Gravitation program of the Dutch Ministry of Education, Culture, and Science and the Netherlands Organization for Scientific Research (NWO grant number 024.004.017). EXPANSE has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874627. Publisher Copyright: © 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2022/2
Y1 - 2022/2
N2 - 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: [Figure not available: see fulltext.]
AB - 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: [Figure not available: see fulltext.]
KW - Built environment
KW - Exposome
KW - Food environment
KW - Lifestyle
KW - Metabolomics
KW - Microbiome
KW - Physico-chemical environment
KW - Review
KW - Social environment
KW - Type 2 diabetes
UR - http://www.scopus.com/inward/record.url?scp=85119253343&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00125-021-05618-w
DO - https://doi.org/10.1007/s00125-021-05618-w
M3 - Review article
C2 - 34792619
SN - 0012-186X
VL - 65
SP - 263
EP - 274
JO - Diabetologia
JF - Diabetologia
IS - 2
ER -