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Understanding the link between environmental exposures and health: does the exposome promise too much?
  1. Annette Peters1,2,
  2. Gerard Hoek3,
  3. Klea Katsouyanni4
  1. 1Helmholtz Zentrum München—German Research Center for Environmental Health, Institute of Epidemiology II, Neuherberg, Germany
  2. 2Harvard School of Public Health, Department of Environmental Health, Boston, Massachusetts, USA
  3. 3Institute of Risk Assessment Sciences, University Utrecht, Utrecht, The Netherlands
  4. 4Department of Hygiene and Epidemiology, University of Athens Medical School, Athens, Greece
  1. Correspondence to Professor Annette Peters, Institute of Epidemiology II, Helmholtz Zentrum München, Ingolstädter Landstr 1, Neuherberg 85764, Germany; peters{at}


Environmental exposures affecting human health range from complex mixtures, such as environmental tobacco smoke, ambient particulate matter air pollution and chlorination by products in drinking water, to hazardous chemicals, such as lead, and polycyclic aromatic hydrocarbons, such as benz(a)pyrene. The exposome has been proposed to complement the genome and be the totality of all environmental exposures of an individual over his or her lifetime. However, if measurements of the exposome in biological samples are the sole tool for exposure assessment there are a number of limitations. First, it has limited utility for fully capturing the impact of complex mixtures such environmental tobacco smoke or particulate matter air pollution. Second, a number of relevant environmental exposures such as noise, heat or electromagnetic fields do not have direct correlates as metabolites or protein adducts, but there is important evidence linking them with health effects. Third, functional genomic changes are likely in many instances to be both a susceptibility factor and a marker of internal doses in response to environmental exposures. Fourth, internal dose measurements of environmental exposures might have lost the distinct signature of the relevant sources. This paper emphasises the obligation of environmental epidemiology to provide robust evidence to assist timely and sufficient protection of vulnerable subgroups of populations from environmental hazards. Therefore, in applying the exposome concept to environmental health problems, a strong link with the external environment needs to be maintained.

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.

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