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Body mass index (BMI) does not distinguish between fat mass, fat-free mass, or the distribution of adipose tissue, which limits its usefulness as a marker of health status in older adults. The objective was to evaluate the relationship between BMI and fat mass index (FMI), fat-free mass index (FFMI), and the fat mass/fat-free mass ratio (FM/FFM), and to study their association with physical function, cognitive status, and nutritional status in rural older adults. A cross-sectional study was conducted among 302 older adults (?65 years) from the rural parishes of Sinincay, Ricaurte, and El Valle (Cuenca, Ecuador). Body composition was measured using bioelectrical impedance analysis (BIA), and the following scales were administered: the Mini Nutritional Assessment (MNA), the Yesavage Geriatric Depression Scale, the Mini-Mental State Examination (MMSE), the Tinetti Scale (gait and balance), and the Lawton and Brody Instrumental Activities of Daily Living Scale. BMIM, FFMI, and MG/MLG were classified into tertiles (T1 minimum, T3 maximum) and stratified by BMI. The mean age was 74.2 ± 7.6 years; 67.9% were women. The highest tertile of FFMI and FM/BML ratio was associated with older chronological and biological age, higher visceral fat, and lower scores on the total Tinetti Scale (p=0.043 and p=0.046, respectively). The highest FFMI tertile was associated with younger biological age, greater muscle mass, and better scores on the MMSE (p=0.001). The MNA score did not differ significantly across tertiles for any of the three indices. In the adjusted linear regression analysis, BMI was the only independent predictor of the total Tinetti score (?=?0.193; 95% CI ?0.384 to ?0.002; p=0.048). Among older adults living in rural areas of Cuenca, higher relative adiposity (BMI and fat-to-lean mass ratio) is associated with impaired balance and gait as measured by the Tinetti Scale, whereas higher fat-free mass (FFMI) protects cognitive function. FFMI and the FM/LFM ratio are better predictors of functional and cognitive status than BMI alone. Interventions aimed at increasing fat-free mass could reduce the risk of falls and cognitive decline in this population.
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