Obesity, diabetes and longevity in the Gulf: is there a Gulf Metabolic Syndrome?

The Gulf is experiencing a pandemic of lifestyle-induced obesity and type 2 diabetes mellitus (T2DM), with rates exceeding 50 and 30%, respectively. It is likely that T2DM represents the tip of a very large metabolic syndrome iceberg, which precedes T2DM by many years and is associated with abnormal/ectopic fat distribution, pathological systemic oxidative stress and inflammation. However, the definitions are still evolving with the role of different fat depots being critical. Hormetic stimuli, which include exercise, calorie restriction, temperature extremes, dehydration and even some dietary components (such as plant polyphenols), may well modulate fat deposition. All induce physiological levels of oxidative stress, which results in mitochondrial biogenesis and increased anti-oxidant capacity, improving metabolic flexibility and the ability to deal with lipids. We propose that the Gulf Metabolic Syndrome results from an unusually rapid loss of hormetic stimuli within an epigenetically important time frame of 2-3 generations. Epigenetics indicates that thriftiness can be programmed by the environment and passed down through several generations. Thus this loss of hormesis can result in continuation of metabolic inflexibility, with mothers exposing the foetus to a milieu that perpetuates a stressed epigenotype. As the metabolic syndrome increases oxidative stress and reduces life expectancy, a better descriptor may therefore be the Lifestyle-Induced Metabolic Inflexibility and accelerated AGEing syndrome – LIMIT-AGE. As life expectancy in the Gulf begins to fall, with perhaps a third of this life being unhealthy – including premature loss of sexual function, it is vital to detect evidence of this condition as early in life as possible. One effective way to do this is by detecting evidence of metabolic inflexibility by studying body fat content and distribution by magnetic resonance (MR). The Gulf Metabolic Syndrome thus represents an accelerated form of the metabolic syndrome induced by the unprecedented rapidity of lifestyle change in the region, the stress of which is being passed from generation to generation and may be accumulative. The fundamental cause is probably due to a rapid increase in countrywide wealth. This has benefited most socioeconomic groups, resulting in the development of an obesogenic environment as the result of the rapid adoption of Western labour saving and stress relieving devices (e.g. cars and air conditioning), as well as the associated high calorie diet

CONTROL OF HYPERTENSION IN EASTERN SAUDI ARABIA: RESULTS OF SCREENING CAMPAIGN

Objective: To assess the pattern of follow-up and level of hypertension control according to sociodemographic, and clinical risk factors in the participants of a screening campaign. Research Design and Methods. In 2004, all Saudi residents in the Eastern Province, aged 30 years and above, were invited to participate in a screening campaign for the early detection of diabetes and hypertension. A structured questionnaire was completed during a face-to-face interview. The presence of hypertension and the place of follow-up were recorded. Blood pressure was measured by trained nurses using a mercury sphygmomanometer, according to the recommendations of The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII). Results: Thirteen point one percent of the participants had been previously diagnosed as having hypertension. In 34.3% of them, blood pressure was controlled, while 40.8% had combined uncontrolled SBP and DBP, 14.4% had isolated uncontrolled SBP, and 10.5% had isolated uncontrolled DBP. The blood pressure control was inversely associated with age. It was higher in women, singles, the educated, in those with BMI of less than 25 kg/m [2] , and in those with positive history of CVD (p<0.001). Conclusion: Co-morbidities relevant for hypertension are very prevalent, so aggressive BP control is mandatory