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El índice de masa corporal (IMC) no permite distinguir entre masa grasa, masa libre de grasa ni la distribución del tejido adiposo, lo que limita su utilidad como marcador del estado de salud en adultos mayores. El objetivo fue evaluar la relación del IMC con el índice de masa grasa (FMI), el índice de masa libre de grasa (FFMI) y el cociente masa grasa/masa libre de grasa (MG/MLG), y estudiar su asociación con función física, estado cognitivo y nutricional en adultos mayores rurales. Estudio transversal realizado en 302 adultos mayores (?65 años) de las parroquias rurales Sinincay, Ricaurte y El Valle (Cuenca, Ecuador). Se midió composición corporal por bioimpedancia eléctrica (BIA) y se aplicaron las escalas Mini Nutritional Assessment (MNA), Escala de Depresión Geriátrica de Yesavage, Miniexamen del Estado Mental (MMSE), Escala de Tinetti (marcha y equilibrio) y Escala de Actividades Instrumentales de la Vida Diaria de Lawton y Brody. El FMI, FFMI y MG/MLG se clasificaron en tertiles (T1 mínimo, T3 máximo) y se estratificaron por IMC. La edad media fue 74.2 ± 7.6 años; 67.9% fueron mujeres. El mayor tertil de FMI y cociente MG/MLG se asoció con mayor edad cronológica y corporal, mayor grasa visceral y peores puntuaciones en la Escala de Tinetti total (p=0.043 y p=0.046, respectivamente). El tertil más alto de FFMI se asoció con menor edad corporal, mayor masa muscular y mejores puntuaciones en el MMSE (p=0.001). La puntuación MNA no difirió significativamente entre tertiles de ninguno de los tres índices. En el análisis de regresión lineal ajustado, el FMI fue el único predictor independiente del puntaje Tinetti total (?=?0.193; IC95% ?0.384 a ?0.002; p=0.048). En adultos mayores rurales de Cuenca, mayor adiposidad relativa (FMI y cociente MG/MLG) se asocia con deterioro del equilibrio y la marcha medido por la Escala de Tinetti, mientras que mayor masa libre de grasa (FFMI) protege la función cognitiva. El FFMI y el cociente MG/MLG son mejores predictores del estado funcional y cognitivo que el IMC aislado. Intervenciones orientadas al incremento de la masa libre de grasa podrían reducir el riesgo de caídas y deterioro cognitivo en esta población.
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Derechos de autor 2026 Diana Fernanda Ramón Paredes, Francy Hollminn Salas Contreras, Fredy Eduardo León Martinez