Anthropometric, Muscle Function, Physical Activity, Inflammatory and Dietary Characteristics Associated With Fasting Glucose and Insulin Resistance in Rural and Urban Malawian Adults: A Cross‐Sectional Study

ABSTRACT Aims In African populations, Type 2 diabetes often occurs at relatively low BMI. We examined anthropometric, muscle function, physical activity, inflammatory and dietary correlates of fasting glucose and insulin resistance. Materials and Methods Nutrition and Metabolic Health in Malawi (NUTRI‐MET Malawi) recruited 100 adults from rural Karonga and urban Lilongwe stratified by glycaemic status at the time of an earlier population survey (50 impaired fasting glucose [IFG] and 50 normoglycaemic) and matched for age, sex and location. Participants underwent anthropometry, handgrip strength, accelerometer‐measured physical activity, dietary and biomarker assessment. As glycaemic status changed in some participants, analyses used current fasting glucose and homeostasis‐model‐estimated insulin resistance (HOMA‐IR) adjusted for age, sex and location. Results Central adiposity, lower relative grip strength and lower physical activity were associated with higher fasting glucose and HOMA‐IR. Each 0.1 higher waist‐to‐hip ratio was associated with 0.420 mmol L −1 higher fasting glucose (95% CI: 0.143–0.696) and 58.1% higher HOMA‐IR (31.5%–90.2%). Each 0.1 kg per kg body mass higher relative grip strength was associated with 0.199 (0.042–0.356) mmol L −1 lower fasting glucose and 19.9% (10.8%–28.0%) lower HOMA‐IR. Central adiposity and relative grip strength together accounted for 24%–26% of HOMA‐IR variance, in models including age, sex and location. Each 30 min day −1 spent inactive was associated with 8.8% higher HOMA‐IR, and 10 min day −1 vigorous activity with 11.9% lower HOMA‐IR. Higher white blood cell count was associated with higher HOMA‐IR. Dietary characteristics showed no clear associations. Conclusions Central adiposity, relative grip strength and physical activity were important correlates of glycaemia and insulin resistance in this relatively lean, highly active population.