The interplay between genetic and lifestyle obesity-related risk factors could be an important reason for the increasing epidemic of diabetes mellitus.

Introduction: Obesity-related type 2 diabetes (DM) is increasing rapidly and at present reaching epidemic proportions in some Worldwide populations. The aim of this study was to provide new knowledge on the interplay between genetic and lifestyle obesity-related risk factors in populations with the highest incidence of obesity-related diabetes could provide an important tool to help prevent or delay diabetes onset in high-risk groups. Methods: Community free-living individuals visiting primary health centers were recruited to the study following informed written consent. Demographic and clinical characteristics, physical activity, dietary intake and biological markers of DM were measured at baseline and follow up. Validated questionnaires were used to assess physical activity and dietary intakes. A Cox proportional hazards analysis was used to examine the risk of developing diabetes diagnosed using the WHO cut-of-points criterion of HbA1c ≥ 6.5% at follow after adjusting for known clinical risk indicators. Results: A total of 375 Community free-living locals UAE citizens subjects, 348 (93%) of them females and 253 non-locals' expatriates [187 (73%)] females were recruited and followed up for a period of 427 ± 223 days. Using WHO cut-of-points for diagnosing DM (HbA1c ≥ 6.5%), 31 (6%) subjects out of 545 followed up developed DM. Overall local United Arab Emirates (UAE) citizens reported significantly lower levels of physical activity in comparison to non-local expatriates. The Cox proportional hazard model analysis revealed that being obese, UAE national and physically inactive is associated with a significantly increased risk of DM after adjusting for other prognostic indicators [non-UAE national: Odd ratio (95% CI): 0.13 (0.04, 0.47); p=0.002; physically active: 0.31 (0.11, 0.90); p=0.002]. The Kaplan Meier figures show the significantly increased risk of developing DM in physically inactive local UAE citizens compared with expatriates' residents (p<0.05). In contrast risk of developing DM was no different between physically very active UAE nationals compared to non-nationals at follow up (P>0.5). Conclusion: Our finding suggests that physical inactivity in high-risk groups is the most important risk factor for developing DM. Urgent actions are needed to increase physical activity in this high-risk group coupled with further research to understand the reasons for this striking indigenous population variability.