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a cross - sectional study of 17 men and 17 women recruited from an urban and a rural residential area of cameroon was conducted .
ethical approval for the study was obtained from the cameroon national ethics committee , and all participants provided signed informed consent . height and waist circumference
body weight was measured using an electronic scale ( tanita tbf-531 ; tanita u.k . , middlesex , u.k . ) .
fat - free mass was calculated from tbw , assuming a hydration factor of 73% , and fat mass derived as the difference between body weight and fat - free mass .
resting energy expenditure ( ree ) was measured using the medgem handheld indirect calorimeter ( healthetech inc . , golden , co ) . total energy expenditure ( tee )
two baseline urine samples were collected on separate days before the administration of a standard dose of dlw ( 174 mg / kg body wt of oxygen-18 and 70 mg / kg body wt of deuterium ) .
tee was calculated using schoeller 's estimation of co2 production , assuming a respiratory quotient of 0.85 .
paee ( kj  day  kg ) was calculated as 0.9  tee  ree , taking the thermogenic effect of food into account .
aerobic fitness was estimated by linear extrapolation of the individually observed heart - rate response to a standardized step test up to the age - predicted maximum heart rate .
capillary blood glucose was measured after an overnight fast ( fasting blood glucose [ fbg ] ) and then 2 h after ingestion of 75 g glucose dissolved in 250300 ml water ( 2-h postload blood glucose [ 2-h bg ] ) .
this was done using a hemocue b - glucose analyzer ( hemocue , ngelholm , sweden ) .
statistical analyses were done using stata ( version 10 special edition ; statacorp , college station , tx ) .
independent associations of paee with fbg and 2-h bg were assessed by multiple linear regression analyses .
body fat was significantly lower in men than in women ( 18.5  9.3 vs. 34.6  7.2% ; p < 0.001 ) ; however , the difference in bmi was of borderline significance ( 25.4  3.6 vs. 28.4  5.1 kg / m ; p = 0.05 ) . tee ( 191.4  55.9 vs. 143  22.6 kj  kg  day ; p = 0.002 ) and paee ( 73.9  49.7 vs. 45.4  17.4 kj  kg  day ; p = 0.03 ) were significantly higher in men than in women .
there was no difference in mean fbg ( 4.3  0.7 vs. 4.6  0.6 mmol / l ; p = 0.21 ) or 2-h bg ( 5.9  1.8 vs. 6.3  1.1 mmol / l ; p = 0.43 ) between men and women .
bmi , waist circumference , and body fat were not significantly correlated with fbg or 2-h bg .
paee was not significantly correlated with fbg ( r = 0.11 ; p = 0.53 ) but inversely correlated with 2-h bg ( r = 0.43 ; p = 0.011 ) . in unadjusted linear regression analyses ( table 1 ) , paee was significantly negatively associated with 2-h bg (  = 0.016 [ 95% ci 0.028 to 0.004 ] ) .
this association remained largely unchanged when adjusted for age , sex , smoking , and alcohol consumption ( 0.018 [ 0.032 to 0.004 ] ) .
further adjustments for bmi , waist circumference , body fat , or vo2max ( table 1 ) did not change the results .
in a sample of nondiabetic cameroonian adults with bmi comparable with that of national survey data ( 2 ) , we observed a strong inverse association between paee and 2-h plasma glucose but not fasting plasma glucose independent of obesity / adiposity .
this association was unchanged after adjustment for age , sex , smoking , and alcohol consumption as confounders and also was not affected by adjustment for cardiorespiratory fitness .
there were borderline significant associations between paee and body fat with fbg , but no significant associations were observed among bmi , waist circumference , or cardiorespiratory fitness with fbg or 2-h bg in this study . the difference in pattern of association between paee and 2-h bg or fbg may relate to the fact that these biochemical parameters reflect different pathophysiological processes ( 3 ) . because the risk of future diabetes , as well as cvd outcomes , is more closely associated with impaired glucose tolerance than with impaired fasting glucose ( 4 ) , our observations have public health importance for the prevention of these metabolic disorders .
the cross - sectional nature of these analyses limits any inference about the direction of causality .
however , the results from trials are unequivocal about the role of physical inactivity in the development of diabetes ( 5 ) .
the small sample size of this study could have limited the statistical power to detect an association between paee and 2-h bg
. however , the precise measurement of the exposure , as used in the present study , acts to increase statistical power and may be one explanation for our ability to detect this association in a small study .
our results are in agreement with other studies in caucasians using objective measurement of physical activity with adjustment for measurement error ( 6 ) .
they are also in agreement with studies in other ethnic groups , which have used less precise measures of paee but larger samples ( 7 ) .
this is the first report of objectively measured free - living paee and its association with glucose tolerance in an african population .
these results suggest that low levels of paee may be a factor underlying the rise of diabetes in this population ( 8) . public health efforts to increase overall paee could play an important role in diabetes prevention and cvd reduction in developing countries .
objective  we examined the cross - sectional association between objectively measured free - living physical activity energy expenditure ( paee ) and glucose tolerance in adult cameroonians without known diabetes.research design and methods  paee was measured in 34 volunteers using the doubly labeled water method and indirect calorimetry ( resting ) . 
 fasting blood glucose and 2-h postload blood glucose were measured during a standard 75-g oral glucose tolerance test.resultsthere was a significant negative correlation between paee and 2-h glucose ( r = 0.43 ; p = 0.01 ) but not fasting glucose ( r = 0.1 ; p = 0.57 ) . 
 the inverse association between paee and 2-h glucose remained after adjustment for age , sex , smoking , alcohol consumption , and bmi (  = 0.017 [ 95% ci 0.033 to 0.002 ] ) and was unchanged after further adjustment for waist circumference , body fat percentage , or aerobic fitness.conclusionspaee is inversely associated with 2-h glucose independently of adiposity or fitness . 
 interventions aimed at increasing paee could play an important role in diabetes prevention in developing countries .