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In developing countries diabetes is considered a new burden in public health and current data clearly indicate that, likely, protective factors present in the African rural vs. urban populations influence the prevalence of the disease. African patients have also fewer dietary and nutritional confounding variables than do people living in Western countries. However, the paucity and the tack of consistency of data available do not allow drawing any certain conclusions. We hypothesized that diabetes in rural areas of Africa is an ideal model to understand which factors are protective to develop the disease and in turn to find interventions that can prevent the onset or the progression of the disease. We have investigated 762 consecutive subjects (204 males and 558 females) living in a rural area of Southern Cameroon, with age ranging from 18 to 90 years. All subjects were interviewed on diabetes risk factors, underwent a clinical examination and blood draw to measure fasting blood glucose (TO), biochemical parameters and genetic analysis; in part of the subjects (484) glucose was measured also after 2 hours of glucose load (T2). Taking into account T2, 15.2% of the study subjects had glucose intolerance and 5.2% were diagnosed with diabetes, 39.7% had BMI lower than 25, 33.6% were overweight (BMI between 25 and 30) and 26.7% were obese (BMI>30). Those showing the highest BMI had a significant higher TO (P=0.03) and lower age compared to those with normal body weight (P=0.003). Daily physical activity was reported in 85.3% of subjects and those who were more active had a significant lower TO and T2 than those who conducting sedentary life (P<0.01 and P=0.02, respectively). Interestingly, the diet of the study subjects was mostly based on vegetables and rice. In conclusion, our study indicates that subjects from rural areas of Cameroon exhibit high BMI and a prevalence of type 2 diabetes similar to that of developed countries despite lack of known risk factors associated with type 2 diabetes. Further investigation focused on biochemical parameters and mostly on the genetic background is in progress and it may contribute to explain how the lack of known risk factors in these subjects is associated to high prevalence of the disease. [ABSTRACT FROM AUTHOR]