Integrating the genome and exposome for precision health in Kuwait

In the heart of the Arabian desert, Kuwait has some of the world’s highest rates of chronic diseases. Seven in ten adults are overweight or obese, and a quarter has diabetes. With summer temperatures topping 50 °C and choking dust storms; the stakes for health could not be higher.

For decades, scientists have tried to untangle why certain populations suffer disproportionately from chronic conditions. Genetic advances, including genome-wide association studies and national genome projects, promised to illuminate inherited risks. Yet even after sequencing millions of genomes, the puzzle remains incomplete.

Genes account for only a fraction of the risk. The rest comes from the environment; the air we breathe, the food we eat, and the stresses we endure, which play a major role in chronic conditions like diabetes and obesity. This is where ‘the exposome’ enters.

The idea of the Exposome

The exposome captures the sum of environmental exposures accumulated across a lifetime. Think of it as a molecular diary; air pollutants, diet, noise, chemicals, climate extremes, even psychosocial stressors, all etched into biological signatures. Just as genomics catalogues inherited variation, exposomics seeks to map this shifting external landscape.

Technology allows us to measure exposures with the same rigour applied to DNA. Satellites can track fine-grained pollution, wearable sensors monitor heat and activity, and test kits detect chemical traces in blood.

Integrating genome and exposome could help us understand who is at risk, why, and under which conditions.  In our recent commentary on precision health in Kuwait, in Nature Reviews Genetics, we argued that bringing genetic and environmental insights together can help capture the true drivers of disease.

Kuwait as a Natural Laboratory

Few places illustrate the urgency of this integration more vividly than Kuwait. The country is at the far-right tail of global heat distributions, with climate change set to raise average temperatures another five degrees by century’s end. Dust storms blanket cities, with fine particulate pollution breaching the World Health Organization limits on nearly nine out of ten days.

Environmental extremes worsen health outcomes directly, supported by our study published in BMJ Diabetes Research & Care.  Hot days alone were linked to hundreds of excess hospitalizations for diabetes each year, while increases in dust concentration added further admissions.

When heat and dust coincided, the risks were compounded, sharply increasing the likelihood of hospital admissions among people with diabetes. These extremes intensify diabetes complications, fuel inflammation, and strain hospital services.

At the same time, Kuwait’s genetic landscape is distinctive. High rates of consanguinity (marriage among relatives) have produced a relatively homogeneous population with certain hereditary traits occurring more frequently. For researchers, this presents a unique opportunity: a controlled setting to study how specific genetic predispositions interact with relentless environmental stressors.

Do certain variants protect against heat-induced cardiovascular strain? Are others particularly vulnerable to dust-triggered inflammation? Answering such questions could provide insights that benefit not only Kuwaitis, but populations worldwide facing rising heat and pollution.

A Chance for integration

Kuwait is yet to launch a national genome project, unlike its Gulf neighbours. But being late may prove an advantage. Instead of replicating earlier models that focused narrowly on DNA, Kuwait can design a programme that integrates exposome data from the start.

Such a programme could sequence genomes while simultaneously collecting high-resolution exposure data including; air quality and climate records, personal sensor readouts, biomarkers of chemical pollutants, and lifestyle surveys.

Artificial intelligence could knit these data streams together, revealing patterns invisible to any single layer. The result would be a model of how environment and inheritance combine to shape disease. If successful, other nations with harsher climates, high pollution, or rising chronic disease rates could replicate this model.

This opportunity does not stop at Kuwait’s borders. The Gulf region already hosts advanced biomedical ecosystems. Qatar has built strong genomics and health research platforms, while the United Arab Emirates has rapidly expanded its genomic medicine programs. By aligning efforts, sharing expertise, pooling resources, and coordinating strategies, the region could shape the standards for genome–exposome science.

The idea of integrating genomic information with environmental exposure data is beginning to gain real momentum in Kuwait, with efforts to connect genetics, environmental factors, and precision medicine into a unified vision for health.

What is required now is political will. Mobilizing resources for such an initiative demands courage and clarity of purpose. But the payoff is immense: healthier lives for Gulf citizens, and a template for tackling chronic disease in an age of climate stress.

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