The exposome: a new paradigm for the water sector?

KWR teams up with Utrecht University to investigate the role of water as an environmental factor affecting human health

This year, KWR launched an exploratory study of the role of water in the exposome in close collaboration with the Institute for Risk Assessment Sciences (IRAS) at Utrecht University. The idea is that the project will shed light on the opportunities and implications of the exposome concept for the water sector. A brief introduction follows here to a relatively young field of research that could result in a paradigm shift.

Do you smoke and what do you eat? What is your socio-economic position? Do you live in the city or in the country? And how clean or dirty is the air you breathe? These are just some of the environmental factors that are important for our health. Roel Vermeulen, Professor of Environmental Epidemiology and Exposome Analysis at Utrecht University and Utrecht University Medical Centre, knows just how important those factors are. “An estimated seventy percent of all chronic diseases in today’s Western world are linked to how they interact throughout our lives and affect our health. Together, they are known as the ‘exposome’, a term that includes the word ‘exposure’, and ‘ome’, which is used in biology as a term for ‘complete’. We launched the Dutch exposome research programme (Exposome-NL) in 2020 to shape this relatively young research area in the Netherlands. We gradually discovered that there was a gap in our knowledge about water. That was when we turned to KWR.”

Paradigm shift

Mapping the exposome is a massive undertaking, Vermeulen explains. He compares it to the human genome. “Deciphering our genetic code requires just one machine in a lab. But there is no such machine for measuring our environment. You need to link different measurement techniques and datasets to health records at the same time to see whether there are relationships, because environmental factors never work in isolation. We are talking about a holistic approach with interventions that affect multiple factors simultaneously. This represents a paradigm shift: a new way of thinking about the impact of the environment on our health.”

Interaction between disciplines

Milou Dingemans, KWR’s Chief Science Officer, believes that the exposome perspective has a lot of potential for the water sector. “It’s about making a realistic assessment of the risks from the environment,” she says. “And not looking at a single substance or a single route, like water. For me as a toxicologist, that overall picture is very important. When you know more about the combined impact, you can devise better measures, and concentrate them more precisely on the desired effect of reducing exposure and risks. I am very pleased that a focus group was set up for the exploratory study with experts from Utrecht University. The IRAS experts have valuable knowledge in the domain of exposure studies and epidemiology that allows different types of exposure to be linked to health effects. It’s great to be working with them.” Representatives from theme groups in the collective research programme for the water sector are also participating, says Dingemans. These are the theme groups Chemical Safety and Customer, as well as the core group Water in the Circular Economy (WiCE). The researcher says that the project resulted in an interesting network. In addition, the exposome perspective encourages people to look beyond the boundaries of their own discipline. “I think that’s a great result in itself,” says Dingemans.


Vermeulen says that the alliance with KWR is essential to roll out exposome research in the water sector. He sees it as a good start to the Academic Workshop on Healthy and Safe Water, which took shape this summer. “On the one hand, KWR has a lot of knowledge about types of potential exposure for humans through water, such as microplastics or chemicals. On the other hand, the corona pandemic is one example that also demonstrated how relevant sewage studies are. KWR’s capacity to detect SARS-CoV-2 in sewers at the time made a hugely valuable contribution to our understanding of the presence and spread of the virus in specific populations. It is this technological monitoring capability that makes KWR so strong.”

Opportunities and implications

The researcher believes that KWR’s close links with the drinking water sector are even more important. “It’s not just about developing knowledge as such but also about the link with possible action. You can only do that if you involve the whole chain. As the knowledge partner of the drinking water utilities, KWR has the ultimate key position in this respect. With KWR on board, we can think about the significance of exposome research for the water sector, and the opportunities and implications. A drinking water sector that has mastered the exposome concept can contribute to public health. Not that the water in the Netherlands is unsafe now. Not at all. But to take the sewage monitoring I mentioned earlier as an example, it would be great to tackle this area with the water companies. As well as the question of what we need to ensure drinking water stays safe, now and in the future. I expect the exposome to fulfil a strong signal function. It will allow us to intervene quickly when necessary, and to involve prevention in the management of product development. With a health sector that is under such intense pressure, it is imperative to do all we can to make sure environmental factors don’t make people ill. And you mustn’t underestimate the role of water.”

Comprehensive and complex

It will be clear that exposome research is comprehensive and complex. So there are challenges ahead. For example, how can the various factors be combined so that they are measurable? How can insights be established for application to health? And how do those insights result in actual interventions that can be evaluated in terms of efficacy? There is still a long way to go, and Vermeulen prefers to talk about one step at a time. The particularly nice thing about this exploratory research, thinks the exposome expert, is the interaction with KWR and the drinking water utilities. “It’s exciting to get together and think about how to shape the research so that it provides possible ways for stakeholders to take action.  You have to do that before the research begins, not after. Only then can you achieve co-creation with the most impact.”

Exploratory research looking at the opportunities and implications of the exposome concept for the water sector will continue throughout the year. At a later stage, we will publish the results and follow-up steps on the KWR website.