and everything we have come up with is that it is about 90% genetic (I know NO ONE wants to hear this) and 10% insult.
So if you have the genes and live a lifestyle designed to prevent the disease, you may gain a few years. If you are merely inclined, you may live the perfect lifestyle and still develop the syndrome after an insult (accident, illness).
The good news is that we have adequate tools to detect it early and deal with it, but it does require very, very early intervention and for those who inherit a nice strong set of genes tending toward metabolic disorder, it requires very early medicine.
The major factor in modern society is that these people need to be constantly physically active, and most modern jobs require you to sit still in one place for long hours after your day. Aside from the primary lipid disorders, everything points to the fact that these people have inherited complexes of genes that make them very good at surviving starvation, and for many of them, that includes gene complexes that very quickly shut down a good part of the circulation to all the parts of their bodies that they are not currently using, including the gastic tract. These people can run on trickle power.
So calorie restriction without constant physical activity doesn't work for them. It makes their syndrome worse.
However, you might find slightly higher levels of chemicals in the bodies of those with these gene complexes, because the first symptom is vasoconstriction for many, and that's on the microvascular level. So they do have a harder time getting some of this stuff out of their bodies.