Exposome Profiles and Asthma among French Adults
Alicia Guillien, Annabelle Bédard, Orianne Dumas, Julien Allègre, Nathalie Arnault, Audrey Bochaton, Nathalie Druesne‐Pecollo, Dorothée Dumay, Léopold Fezeu, Serge Herçberg, Nicole Le Moual, Hugo Pilkington, Stéphane Rican, Guillaume Sit, Fabien Szabo de Edelenyi, Mathilde Touvier, Pilar Galán, Thierry Feuillet, Raphaëlle Varraso, Valérie Siroux
Abstract
Abstract RationaleAlthough previous studies in environmental epidemiology focused on single or a few exposures, a holistic approach combining multiple preventable risk factors is needed to tackle the etiology of multifactorial diseases such as asthma. ObjectivesTo investigate the association between combined socioeconomic, external environment, early-life environment, and lifestyle-anthropometric factors and asthma phenotypes. MethodsA total of 20,833 adults from the French NutriNet-Santé cohort were included (mean age, 56.2 yr; SD, 13.2; 72% women). The validated asthma symptom score (continuous) and asthma control (never asthma, controlled asthma, and uncontrolled asthma) were considered. The exposome (n = 87 factors) covered four domains: socioeconomic, external environment, early-life environment, and lifestyle-anthropometric. Cluster-based analyses were performed within each exposome domain, and the identified profiles were studied in association to asthma outcomes in negative binomial (asthma symptom score) or multinomial logistic (asthma control) regression models. Measurements and Main ResultsIn total, 5,546 (27%) individuals had an asthma symptom score ⩾1, and 1,206 (6%) and 194 (1%) had controlled and uncontrolled asthma, respectively. Three early-life exposure profiles (“high passive smoking–own dogs,” “poor birth parameters–daycare attendance–city center,” or “⩾2 siblings–breastfed” compared with “farm–pet owner–molds–low passive smoking”) and one lifestyle-anthropometric profile (“unhealthy diet–high smoking–overweight” compared with “healthy diet–nonsmoker–thin”) were associated with more asthma symptoms and uncontrolled asthma. ConclusionsThis large-scale exposome-based study revealed early-life and lifestyle exposure profiles that were at risk for asthma in adults. Our findings support the importance of multiinterventional programs for the primary and secondary prevention of asthma, including control of specific early-life risk factors and promotion of a healthy lifestyle in adulthood.