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Abstract
Promoting healthy aging is a preventive strategy that has a positive impact on both the health of older adults and the healthcare system. Falls are the leading cause of injury in this population and result in a high economic and healthcare burden. To assess the association between body composition, nutritional status, and the risk of falls among older adults living in rural areas of Ecuador. A cross-sectional study conducted between 2022 and 2023 involving older adults aged 65 years or older, recruited through non-probabilistic convenience sampling at primary care centers and community programs in rural parishes of the province of Azuay, Ecuador. Permanent residents capable of providing informed consent were included. Individuals with severe cognitive impairment, disabilities that prevented bioimpedance analysis, or acute illness were excluded. A total of 316 older adults participated (mean age 74.3 ± 7.6 years; range 65–95 years), of whom 217 (68.7%) were women. Of 316 participants, 85 (26.9%) were at high risk of falls, 58 (18.4%) at moderate risk, and 171 (54.1%) at low risk. Nutritional status was the most important independent predictor of the Tinetti score in the overall model (? = ?0.339; p < 0.001), among women (? = ?0.360; p < 0.001), and among men (? = ?0.308; p = 0.004). BMI was also a significant predictor in the overall model (? = ?0.176; p = 0.005) and among women (? = ?0.223; p = 0.001), but not among men. Nutritional status and BMI are the main modifiable predictors of fall risk among older adults in rural Ecuador, especially among women. Interventions aimed at preventing malnutrition and excess weight should be incorporated into fall prevention protocols in rural primary care.
References
Almeida, L. A., Dantas, B. A. da S., Rocha, K. P. de M., Araújo, M. P. D., Andrade, N. da L., Batista, F. de A. M., dos Santos Silva, R. L., Silvino, M. L. M., Barbosa, L. B. da S. F., Medeiros de Oliveira, M., Nobre, T. T. X., Távora, R. C. de O., Oliveira, A. C. de S., & de Vasconcelos Torres, G. (2025). Nutritional, cognitive, and functional deficits, frailty, and quality of life associated with fall risk in community-dwelling older adults: A cross-sectional study conducted in Brazil. Journal of Primary Care & Community Health, 16. https://doi.org/10.1177/21501319251341742
Ardaneh, M., Fararouei, M., & Hassanzadeh, J. (2023). Falls leading to fracture and nutrition among older adults: A case–control study. Journal of Health, Population and Nutrition, 42(1). https://doi.org/10.1186/s41043-023-00361-x
Beck Jepsen, D., Robinson, K., Ogliari, G., Montero-Odasso, M., Kamkar, N., Ryg, J., Freiberger, E., & Tahir, M. (2022). Predicting falls in older adults: An umbrella review of instruments assessing gait, balance, and functional mobility. BMC Geriatrics, 22(1). https://doi.org/10.1186/s12877-022-03271-5
Bennett, J. P., & Lim, S. (2025). The critical role of body composition assessment in advancing research and clinical health risk assessment across the lifespan. Journal of Obesity & Metabolic Syndrome, 34(2), 120–137. https://doi.org/10.7570/jomes25010
Campoverde, J., González, J., & Pérez, A. (2022). Risk of falls in older adults in the rural region case study Paccha Cuenca, Ecuador. International Conference on Information and Communication Technologies for Ageing Well and E-Health, ICT4AWE – Proceedings. https://doi.org/10.5220/0011000600003188
Chapelon, J., Sourdet, S., Angioni, D., Steinmeyer, Z., Briand, M., Rolland, Y., & Abellan van Kan, G. (2025). Body composition of older adults with normal body mass index: Cross-sectional analysis of the Toulouse Frailty Clinic. The Journal of Frailty & Aging, 14(1). https://doi.org/10.1016/j.tjfa.2024.100003
Chen, X., Lin, Z., Gao, R., Yang, Y., & Li, L. (2021). Prevalence and associated factors of falls among older adults between urban and rural areas of Shantou city, China. International Journal of Environmental Research and Public Health, 18(13). https://doi.org/10.3390/ijerph18137050
Choudhury, R., Park, J. H., Banarjee, C., Thiamwong, L., Xie, R., & Stout, J. R. (2023). Associations of mutually exclusive categories of physical activity and sedentary behavior with body composition and fall risk in older women: A cross-sectional study. International Journal of Environmental Research and Public Health, 20(4). https://doi.org/10.3390/ijerph20043595
Danielewicz, A. L., Freitas de Assis, G., Martins Cândido, L., Amaral Mendonça, V., Lacerda, A. C. R., Tringali, G., De Micheli, R., Bondesan, A., Carelli Pereira de Avelar, N., & Sartorio, A. (2026). Sarcopenic obesity and history of falls in older Italian adults: Associations according to different diagnostic combinations. Frontiers in Endocrinology, 16. https://doi.org/10.3389/fendo.2025.1727488
Eckert, C., Gell, N. M., Wingood, M., Schollmeyer, J., & Tarleton, E. K. (2021). Malnutrition risk, rurality, and falls among community-dwelling older adults. The Journal of Nutrition, Health & Aging, 25(5), 624–627. https://doi.org/10.1007/s12603-021-1592-8
Eckert, C. D., Tarleton, E. K., Pellerin, J., Mooney, N., & Gell, N. M. (2022). Nutrition risk is associated with falls risk in an observational study of community-dwelling, rural, older adults. Journal of Aging and Health, 34(6–8), 1125–1134. https://doi.org/10.1177/08982643221096944
Ferrara, P., Monti, C. C., Rozza, D., Fornari, C., Antonazzo, I. C., Ferrara, M. C., Bellelli, G., Brandi, M. L., Mantovani, L. G., & Mazzaglia, G. (2025). Incidence and risk factors for falls among nursing home residents in Italy: A retrospective cohort study. Aging Clinical and Experimental Research, 37(1). https://doi.org/10.1007/s40520-025-03111-7
Hashim, N. N. A., Mat, S., Myint, P. K., Kioh, S. H., Delibegovic, M., Chin, A. V., Kamaruzzaman, S. B., Hairi, N. N., Khoo, S. P. K., & Tan, M. P. (2024). Association between weight and body composition changes with falls risk in the Malaysian Elders Longitudinal Research (MELoR) study. BMJ Open, 14(11). https://doi.org/10.1136/bmjopen-2024-087358
Hidalgo, M., Ibarra, S., Pico, S., Pico, N., & Ponce, J. (2026). Sarcopenia como factor de riesgo de caídas en el adulto mayor: Revisión narrativa para la práctica clínica. Arcana Scientific Journal, 4(1), 38–52. https://doi.org/10.65305/asj.v4n1.2026.43
Jayanama, K., Theou, O., Godin, J., Mayo, A., Cahill, L., & Rockwood, K. (2022). Relationship of body mass index with frailty and all-cause mortality among middle-aged and older adults. BMC Medicine, 20(1). https://doi.org/10.1186/s12916-022-02596-7
Jiménez-Ten Hoevel, C., Queral, J., Besora-Moreno, M., Tarro, L., Sospedra-Senar, A., Tomàs-Piqueras, J., Sepúlveda, C., Valls, R. M., Pedret, A., Solà, R., & Llauradó, E. (2025). Health status, lifestyle and quality of life in older adults of rural and urban areas of Tarragona province (Catalonia, Spain): A cross-sectional descriptive study. BMC Public Health, 25(1). https://doi.org/10.1186/s12889-025-22045-3
Kupisz-Urbanska, M., & Marcinowska-Suchowierska, E. (2022). Malnutrition in older adults—Effect on falls and fractures: A narrative review. Nutrients, 14(15). https://doi.org/10.3390/nu14153123
Li, L. Z., Li, J., Xu, Q., & Ou, X. (2022). The risk of falls among the aging population: A systematic review and meta-analysis. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.902599
Lin, L. H., Liu, X. Y., Cai, C. H., Zheng, Y. K., Li, D., & Hu, G. P. (2025). Urban–rural disparities in fall risk among older Chinese adults: Insights from machine learning-based predictive models. Frontiers in Public Health, 13. https://doi.org/10.3389/fpubh.2025.1597853
Maheshwari, V., & Basu, S. (2023). Sarcopenic obesity burden, determinants, and association with risk of frailty, falls, and functional impairment in older adults with diabetes: A propensity score matching analysis. Cureus, 15(11). https://doi.org/10.7759/cureus.49601
Moradell, A., Gomez-Cabello, A., Mañas, A., Gesteiro, E., Pérez-Gómez, J., González-Gross, M., Casajús, J. A., Ara, I., & Vicente-Rodríguez, G. (2024). Longitudinal changes in the body composition of non-institutionalized Spanish older adults after 8 years of follow-up: The effects of sex, age, and organized physical activity. Nutrients, 16(2). https://doi.org/10.3390/nu16020298
Muhammad, T., Srivastava, S., Hossain, B., & Paul, R. (2022). Decomposing rural–urban differences in successful aging among older Indian adults. Scientific Reports, 12(1). https://doi.org/10.1038/s41598-022-09958-4
Mziray, M., Nowosad, K., ?liwi?ska, A., Chwesiuk, M., & Ma?gorzewicz, S. (2024). Malnutrition and fall risk in older adults: A comprehensive assessment across different living situations. Nutrients, 16(21). https://doi.org/10.3390/nu16213694
Nordling, Y., Sund, R., Sirola, J., Kröger, H., Isanejad, M., & Rikkonen, T. (2024). Body composition, balance, functional capacity and falls in older women. Aging Clinical and Experimental Research, 36(1). https://doi.org/10.1007/s40520-024-02719-5
Nowicki, G. J., Polak, M., & ?lusarska, B. J. (2024). Comparison of anthropometric indicators related to overweight and obesity by place of residence in a local community with a high social deprivation rate – a cross-sectional study. Annals of Agricultural and Environmental Medicine, 31(2), 248–254. https://doi.org/10.26444/aaem/178180
Omaña, H., Bezaire, K., Brady, K., Davies, J., Louwagie, N., Power, S., Santin, S., & Hunter, S. W. (2021). Functional reach test, single-leg stance test, and Tinetti performance-oriented mobility assessment for the prediction of falls in older adults: A systematic review. Physical Therapy, 101(10). https://doi.org/10.1093/ptj/pzab173
Pereira, C., Veiga, G., Almeida, G., Matias, A. R., Cruz-Ferreira, A., Mendes, F., & Bravo, J. (2021). Key factor cutoffs and interval reference values for stratified fall risk assessment in community-dwelling older adults: The role of physical fitness, body composition, physical activity, health condition, and environmental hazards. BMC Public Health, 21. https://doi.org/10.1186/s12889-021-10947-x
Rodrigues, F., Monteiro, D., Monteiro, A. M., & Forte, P. (2026). Interactions between BMI and age on fall risk in older adults. Epidemiologia, 7(1). https://doi.org/10.3390/epidemiologia7010018
Rossini-Venturini, A. C., Veras, L., Abdalla, P. P., Santos, A. P. dos, Tasinafo-Junior, M. F., Silva, L. S. L. da, Alves, T. C., Ferriolli, E., Romo-Perez, V., Garcia-Soidan, J. L., Mota, J., & Machado, D. R. L. (2023). Multicompartment body composition analysis in older adults: A cross-sectional study. BMC Geriatrics, 23(1). https://doi.org/10.1186/s12877-023-03752-1
Song, H., Wei, Y., Wang, Y., & Zhang, J. (2024). The mediating effect of nutrition on oral frailty and fall risk in community-dwelling elderly people. BMC Geriatrics, 24(1). https://doi.org/10.1186/s12877-024-04889-3
Stratidaki, E., Mechili, E. A., Ouzouni, C., Patelarou, A. E., Giakoumidakis, K., Laliotis, A., & Patelarou, E. (2024). A study of factors contributing to the nutritional status of elderly people receiving home care. Nutrients, 16(18). https://doi.org/10.3390/nu16183135
Thiamwong, L., Xie, R., Conner, N. E., Renziehausen, J. M., Ojo, E. O., & Stout, J. R. (2023). Body composition, fear of falling and balance performance in community-dwelling older adults. Translational Medicine of Aging, 7, 80–86. https://doi.org/10.1016/j.tma.2023.06.002
Yu, C., Meng, Z., Wang, X., & Xiao, J. (2025). Associations between sarcopenic obesity and risk of falls: A population-based cohort study among middle-aged and older adults using the CHARLS. BMC Public Health, 25(1). https://doi.org/10.1186/s12889-025-24746-1
Zhang, K., Ju, Y., Yang, D., Cao, M., Liang, H., & Leng, J. (2023). Correlation analysis between body composition, serological indices and the risk of falls, and the receiver operating characteristic curve of different indexes for the risk of falls in older individuals. Frontiers in Medicine, 10. https://doi.org/10.3389/fmed.2023.1228821
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