Obesity, diabetes and longevity in the Gulf: Is there a Gulf Metabolic Syndrome?  Geoffrey W. Guy, Alistair V.W. Nunn, Louise E. Thomas, Jimmy D. Bell  International Journal of Diabetes Mellitus  Volume 1, Issue 1, Pages 43-54 (April 2009) DOI: 10.1016/j.ijdm.2009.05.001 Copyright © 2009 International Journal of Diabetes Mellitus Terms and Conditions

Fig. 1 Recent IDF league table of diabetes rates. International Journal of Diabetes Mellitus 2009 1, 43-54DOI: (10.1016/j.ijdm.2009.05.001) Copyright © 2009 International Journal of Diabetes Mellitus Terms and Conditions

Fig. 2 Rates of obesity in the Gulf compared to other countries. Gulf countries solid lines, non-Gulf countries depicted using broken lines. The shaded band represents a linear prediction. International Journal of Diabetes Mellitus 2009 1, 43-54DOI: (10.1016/j.ijdm.2009.05.001) Copyright © 2009 International Journal of Diabetes Mellitus Terms and Conditions

Fig. 3 Prevalence of the metabolic syndrome globally and in the Gulf. International Journal of Diabetes Mellitus 2009 1, 43-54DOI: (10.1016/j.ijdm.2009.05.001) Copyright © 2009 International Journal of Diabetes Mellitus Terms and Conditions

Fig. 4 Tipping point, hormesis, VAT and healthy life expectancy. International Journal of Diabetes Mellitus 2009 1, 43-54DOI: (10.1016/j.ijdm.2009.05.001) Copyright © 2009 International Journal of Diabetes Mellitus Terms and Conditions

Fig. 5 Loss of hormesis in the Gulf environment. International Journal of Diabetes Mellitus 2009 1, 43-54DOI: (10.1016/j.ijdm.2009.05.001) Copyright © 2009 International Journal of Diabetes Mellitus Terms and Conditions

Fig. 6 Epigenetic canalisation and transfer of ‘stress’ signal (e.g. insulin resistance) through Gulf generations due to lack of hormesis. The ball represents the current phenotype and the canal, the epigenotype. Energy requiring hormetic factors such as exercise, temperature extremes, drought & stress polyphenols widen the canal to the right, whereas energy reducing factors, such as famine/fasting, widen it to the left. Metabolic flexibility is improved in both directions, but famine/fasting reduces energy expenditure, while energy requiring factors increase it. Without any hormetic factors, the canal becomes so narrow that in the presence of excess food, the phenotype falls outside and becomes permanently stressed: this is then passed on to the next generation, so perpetuating the problem. International Journal of Diabetes Mellitus 2009 1, 43-54DOI: (10.1016/j.ijdm.2009.05.001) Copyright © 2009 International Journal of Diabetes Mellitus Terms and Conditions

Fig. 7 A FOTI subject versus a TOFI subject. International Journal of Diabetes Mellitus 2009 1, 43-54DOI: (10.1016/j.ijdm.2009.05.001) Copyright © 2009 International Journal of Diabetes Mellitus Terms and Conditions