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O índice de massa corporal (IMC) não permite distinguir entre massa gorda, massa livre de gordura e distribuição do tecido adiposo, o que limita sua utilidade como marcador do estado de saúde em idosos. O objetivo foi avaliar a relação do IMC com o índice de massa gorda (FMI), o índice de massa livre de gordura (FFMI) e a razão massa gorda/massa livre de gordura (MG/MLG), e estudar sua associação com função física, estado cognitivo e nutricional em idosos rurais. Estudo transversal realizado com 302 idosos (?65 anos) das paróquias rurais Sinincay, Ricaurte e El Valle (Cuenca, Equador). A composição corporal foi medida por bioimpedância elétrica (BIA) e foram aplicadas as escalas Mini Nutritional Assessment (MNA), Escala de Depressão Geriátrica de Yesavage, Miniexame do Estado Mental (MMSE), Escala de Tinetti (marcha e equilíbrio) e Escala de Atividades Instrumentais da Vida Diária de Lawton e Brody. FMI, FFMI e MG/MLG foram classificados em tercis (T1 mínimo, T3 máximo) e estratificados por IMC. A idade média foi 74,2 ± 7,6 anos; 67,9% eram mulheres. O maior tercil de FMI e da razão MG/MLG associou-se a maior idade cronológica e corporal, maior gordura visceral e piores pontuações na Escala de Tinetti total (p = 0,043 e p = 0,046, respectivamente). O tercil mais alto de FFMI associou-se a menor idade corporal, maior massa muscular e melhores pontuações no MMSE (p = 0,001). A pontuação do MNA não diferiu significativamente entre os tercis de nenhum dos três índices. Na análise de regressão linear ajustada, o FMI foi o único preditor independente da pontuação total da Escala de Tinetti (? = ?0,193; IC95% ?0,384 a ?0,002; p = 0,048). Em idosos rurais de Cuenca, maior adiposidade relativa (FMI e razão MG/MLG) associa-se a prejuízo do equilíbrio e da marcha medido pela Escala de Tinetti, enquanto maior massa livre de gordura (FFMI) protege a função cognitiva. O FFMI e a razão MG/MLG são melhores preditores do estado funcional e cognitivo do que o IMC isolado. Intervenções voltadas ao aumento da massa livre de gordura poderiam reduzir o risco de quedas e comprometimento cognitivo nessa população.
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