The exposome and inflammatory bowel disease: a framework for primary and primordial prevention

The role of the environment in inflammatory bowel disease (IBD) is acknowledged as being critical, yet enquiry into the exposome and IBD is limited. Recognizing the exposome as encompassing all physical, chemical, biological and psychosocial factors that influence human health over the lifespan is central to unravelling its role in IBD, as well as overlapping immune-mediated diseases. Here, we summarize the latest in exposome research in IBD, differentiate between early life and later exposures, highlight the limitations of traditional epidemiological methods and introduce lesser-explored exposures (for example, food contact contaminants). We discuss innovation in exposomics, such as high-resolution mass spectrometry platforms, integrative statistics and the relevance of microplastics and nanoplastics, a growing pollutant of concern, in IBD. Next, we highlight the prevention framework, emphasizing the relevance of the actionable exposome and differentiating between primary and primordial prevention. Although the former implies risk stratification and prevention in at-risk individuals, primordial prevention focuses on risk mitigation in the general population. We discuss individual and community-level mitigation strategies and global considerations to lower IBD risk. This Perspective provides a path to implement exposomics in IBD prevention, which might also be relevant towards other chronic health outcomes.