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Epidemiol Prev 2018; 42 (5-6): 37-48
DOI: https://doi.org/10.19191/EP18.5-6.S1.P037.086

Addressing complexity of health impact assessment in industrially contaminated sites via the exposome paradigm

  • Dimosthenis A. Sarigiannis1-3

  • Spyros P. Karakitsios1,2

  1. Department of Chemical Engineering, Environmental Engineering Laboratory, Aristotele Univeristy of Thessaloniki (Greece)
  2. HERACLES Research Center on the Exposome and Health, Center for Interdisciplinary Research and Innovation, Balkan Center, Thessaloniki (Greece)
  3. University School for Advanced Study (IUSS), Pavia, Italy
Dimosthenis A. Sarigiannis -

ARTICLE FREE FULL TEXT (PDF; 2.3 MB)

BACKGROUND: this paper is based upon work from COST Action ICSHNet. Assessment of the health impacts related to industrially contaminated sites (ICSs) is a major scientific challenge with multiple societal implications. Most studies related to associations between ICSs and public health do not provide established mechanistic links between environmental exposure and disease burden, potentially resulting in suboptimal risk management measures.
OBJECTIVES: to assess the potential of the exposome paradigm to overhaul ICS risk assessment and management leading to precision prevention and targeted interventions.
METHODS:
we selected the second largest waste landfill in Europe and the data collected in the frame of the HERACLES study on the exposome and health and analysed them together with clinical evidence of neurodevelopmental perturbations following the exposome-wide association study paradigm using the exposome analysis tools; briefly, these pertain to refined exposure assessment, internal dosimetry, and human biomonitoring, multi-omics/toxicity pathway analysis and advanced statistical tools for environment-wide association studies. Waste streams and the related contamination of environmental media are not viewed in isolation, but rather as components of the expotype, the vector of exposures an individual is exposed to over time. Thus, a multi-route and multi-pathway exposure estimation can be performed setting a realistic basis for integrated health risk and impact assessment. The study was located in the area around the landfill of Fili, outside Athens (Greece). Since 2012, 325 children were recruited and have been followed using a combination of human biomonitoring, advanced-omics analysis on biosamples, environmental monitoring for metals and organic contaminants, and dietary pattern information. The children were clinically tested for neurodevelopmental perturbations during different developmental stages and the results were analysed according to the exposome-wide association study methodology in conjunction with environmental exposure, but also socioeconomic, dietary, and metabolic determinants of internal exposure and health risk.
RESULTS: using the exposome analysis tools, we confirmed that proximity to a landfill and the consequent soil contamination with metals are critical for children neurodevelopment. However, it was found that additional parameters such as parental education level, socioeconomic status, and nutrition contribute either positively or negatively on child neurodevelopment.
CONCLUSIONS: the exposome concept comes to overhaul the nature vs. nurture paradigm and embraces a world of dynamic interactions between environmental exposures, endogenous exposures, and genetic expression in humans. In this context, the exposome paradigm provides a novel tool for holistic ICS health risk management. The effectiveness of the exposome approach is demonstrated in the case of Athens, the capital of Greece, where health effects associated to long term exposure to a major waste management facility (landfill) are presented.

Keywords: industrially contaminated sites, waste, exposome, omics, neurodevelopmental

KEYPOINTS
What is already known

  • Industrially contaminated sites are commonly associated with health problems in the local population after long-term exposure.
  • Proximity to industrially contaminated sites is a common proxy for population exposure.
  • Complex exposures to toxicants characterize the population living close to industrially contaminated sites.

 

What this paper adds

  • The exposome paradigm overhauls the health risk and impact assessment applied in landfills of municipal and industrial waste and in industrially contaminated sites in general.
  • Exposome-wide associations allow joint consideration of all co-determinants of exposure and effects in industrially contaminated sites.
  • Beyond environmental contamination and proximity to the site, dietary patterns, family socioeconomic status, and metabolic variability have been also considered as significant determinants of child neurodevelopment.