Estrella-Castillo and Gómez-de-Regil BMC Geriatrics (2019) 19:339

https://doi.org/10.1186/s12877-019-1363-0

RESEARCH ARTICLE Open Access

Comparison of body mass index range

criteria and their association with cognition,
functioning and depression: a cross-
sectional study in Mexican older adults
Damaris Francis Estrella-Castillo1 and Lizzette Gómez-de-Regil2*

Abstract
Background: World population is living longer, demanding adjustments in public health policies. Body mass index
(BMI) is widely known and used as a parameter and predictor of health status although an adapted criterion for
older adults is usually overlooked. BMI has been extensively analysed in relation to mortality but fewer studies
address its association with cognition, functioning and depression in older adults. The present study aimed at 1)
comparing BMI distribution according to the ranges proposed by the World Health Organization (WHO) and the
United States National Research Council Committee on Diet and Health (CDH), 2) analysing their association with
cognitive functioning, physical functioning and depression and 3) analysing a possible, interaction of BMI criteria
with sex on the outcome measures.
Methods: This cross-sectional study included 395 participants recruited by convenience sampling; 283 (71.6%)
women and 112 (24.58%) men. Mean age was 74.68 (SD = 8.50, range: 60–98). Outcome measures included the
Short Portable Mental State Questionnaire for cognitive status, the Barthel’s Index of Activities of Daily Living for
physical functioning, and the Geriatric Depression Scale.
Results: WHO criterion classified most cases (65.3%) as overweight, followed by normal weight (32.2%) and
underweight (2.5%) whereas CDH criterion considered most (48.1%) as normal weight, and followed by overweight
(31.4%) and underweight (20.5%). Analysing cognitive status, independent physical functioning and depression
mean scores, significant differences (p ≤ .001) were found when comparing the three weight groups (underweight,
normal weight and overweight) using either the WHO- or the CDH criterion. Post-hoc tests revealed that in all
comparisons the underweight group scored the lowest in all three outcome measures. According to the CDH
criterion, overweight was favourable for females but unfavourable for males regarding cognitive status (interaction
F(2,389) = 4.52, p ≤ .01) and independent functioning (interaction F(2,389) = 3.86, p ≤ .05).
Conclusions: BMI and its associations to relevant outcome measures in the older adults must rely on criteria that
take into account the particular features of this population, such as the CDH criterion. Underweight was associated
with decremented cognition, less independent physical functioning and more depression. Overweight seemed
favourable for women but unfavourable for men.
Keywords: Body mass index, Mexican., Elderly., Cognition., Functioning., Depression., Older adults., Ageing.

* Correspondence: [email protected]
2
Hospital Regional de Alta Especialidad de la Península de Yucatán, Calle 7,
No. 433 por 20 y 22, Fraccionamiento Altabrisa. Mérida, 97130 Merida,
Yucatán, Mexico
Full list of author information is available at the end of the article

© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Estrella-Castillo and Gómez-de-Regil BMC Geriatrics (2019) 19:339 Page 2 of 8

Background Dependence implies increased health costs and is the

Population is aging, challenging public policies to respond main concern and cause of suffering and poor quality of
to the particular health demands of this segment. Accurate life in older adults [12]. Although in young adults BMI
body composition information in older adults becomes a does not seem related to daily life functioning [13], in
relevant aim for research and applied settings, with a po- older adults, it is still controversial. Whereas some stud-
tential utility for illness/mortality risk screening, planning, ies have found a higher BMI relates to better daily life
and evaluation of interventions, preventing malnutrition, functioning, even in those with obesity [14], others dif-
developing reference standards for ambulatory and non- fer, finding underweight or obese older people subjects
ambulatory users [1]. Body Mass Index (BMI) is the stand- to have more limitations than those with normal BMI
ard metric of body composition, which adjusts weight-for- [15].. Emotional status is also an important aspect of
height. Although not the only parameter [2, 3], it is cer- health. Depressive disorders affect about 2–3% of older
tainly the most widely used, probably due to its low cost, people living in the community and 10% of those in
simplicity to assess and calculate, and the provision of ref- long-term care facilities. Attention must be given also to
erences by the World Health Organization (WHO) based sub-threshold depression (i.e. substantial depressive
on international data. The WHO provides cut-off points symptoms without meeting the diagnostic criteria), as
for adults aged 25 and older (excluding pregnant and approximately 1 in 10 older adults is likely to experience
breastfeeding women); yet, it acknowledges that in very it [11]. In older adults, depressive symptoms seem re-
aged adults BMI is naturally decreased [4]. lated to both, weight loss and weight gain [16, 17]. Some
Some natural physical changes occur even in healthy, studies have found no sex differences in this association
successfully aging individuals; for instance: weight loss, [16], but others have shown that obesity increases the
sarcopenia (i.e. deficiency of flesh or muscle), increase risk of depression in women, while overweight reduces
and redistribution of fat toward the abdomen, loss of the risk in men [18].
bone and body calcium and in consequence, of height BMI is widely known and used as a standard parameter
[3]. Thus, the WHO criterion for “normal weight” seems and predictor of health status, but adapted criterion for
less reliable for older adults. From other various criteria, older people are usually overlooked. Few studies have ad-
only the one proposed by the United States National Re- dressed the association of BMI with cognition, function-
search Council Committee on Diet and Health (CDH) ing, and depression in older adults. The present study
takes into account age stages of adulthood [5]. aimed at 1) comparing BMI distribution according to the
The prevalence of overweight and obesity is rising, ranges proposed by the WHO and the CDH, 2) analysing
even among older people. A national health survey on their association with cognitive functioning, physical func-
Mexican population [6] found overweight and obesity tioning, and depression and 3) analysing a possible, inter-
rates of 42.5 and 34.5 in adults aged 60 to 69, 39.0 and action of BMI criteria with sex on the outcome measures.
28.3 in adults aged 70 to 79, and 33.8 and 15.7 in adults
aged 80 or older [7]. Obesity is associated with higher Methods
morbidity and mortality, but in older adults, there is a Authorization and ethical approval to perform this cross-
(debatable) “obesity paradox”. Meta-analyses about the sectional study were obtained from the Research and Ethics
relevance of overweight and obesity to mortality in di- Committee of the School of Medicine and Rehabilitation of
verse adult populations suggest that a BMI range of 20– the Autonomous University of Yucatan. Participants were
24.9 kg/m2 is optimal for the lowest risk in adults [8, 9]. recruited by convenience sampling. Through the study
Yet, when participants with a BMI range of 18.5–20.0 period, three independent senior care centres located in the
kg/m2 (low, but still normal according to the WHO) city of Merida (Mexico), two public and one private, were
was omitted, the beneficial effect of overweight vanished visited in order to reach users of age 60 or older and invite
[9]. That led, considering this low BMI group as normal, them to participate. Informed consents were signed volun-
to the false conclusion that overweight is beneficial. tarily, granting confidentiality and with no economic com-
Beyond the low risk of mortality and morbidity health pensation involved.
also implies mental and social well-being. Soon a signifi-
cant portion of the population will be aged and naturally Measures
experiencing health decline. But even while in younger Participants were asked to remove their shoes and any
adults higher BMI increases the risk for impaired cogni- garment worn on the head, stand straight, feet together,
tion and late-onset dementia, in late life relates to better with head, back, buttocks, calves and heels touching the
cognition [10]. Along with physical and/or cognitive stadiometer; height was recorded in centimetres. Before
ability decrements care dependence arises up to a point every weight measurement the scale was balanced to
where the individual is no longer able to undertake, zero and participants were asked to remove their shoes
without the help of others, the basic daily life tasks [11]. and any heavy outer clothing. The person should step
Estrella-Castillo and Gómez-de-Regil BMC Geriatrics (2019) 19:339 Page 3 of 8

on the scale platform and stand motionless for a couple (SD = 5.58, range: 17.26–51.61); no significant differ-
of seconds with weight equally distributed on both feet. ences were found for sex. None of the participants re-
Weight was recorded on kilograms. ported a health condition that might cause weight loss
Weight and height were considered to estimate the Que- or gain (e.g. cancer, heart failure, hypothyroidism).
telet BMI (kg/m2) and classify patients according to two cri- Distribution by BMI according to WHO criterion classi-
teria. The WHO criterion [19] classifies the status of body fies most cases from total (65.3%) sample and, from the
composition as: underweight ≤18.49 kg/m2, normal ≥18.50 male (63.4%) and female (66.1%) subsamples as over-
- ≤24.99 kg/m2, and overweight ≥25.0 kg/m2. The CDH weight. According to CDH criterion, 48.1% from the total
[20] considers weight ranges in people aged 55 to 65 as sample, 50.0% of male subsample and 47.3% of females
underweight < 23 kg/m2, normal 23–28 kg/m2, and over- subsample have a normal weight. Classification of people
weight > 28 kg/m2, and in people aged 66 or older as under- as with overweight by WHO criterion seems to have a
weight < 24 kg/m2, normal 24–29 kg/m2, and overweight > very low threshold in comparison with CDH criterion, as
29 kg/m2. the WHO percentages approximately double those of
Cognitive status was measured using the Short Portable CDH (e.g. 65.3% vs. 31.4%). On the other hand, percent-
Mental State Questionnaire (SPMSQ; Pfeiffer question- ages of underweight for total, male and female samples,
naire) [21]. The level of independent physical functioning according to WHO criterion, were 2.5, 0.0 and 3.5, re-
was assessed with the Barthel’s Index of Activities of Daily spectively. In contrast, according to CDH criterion, per-
Living [22]. Depression was measured with the Geriatric centages were 20.5, 17.9 and 21.6, respectively. See
Depression Scale (GDS) [23]. All three questionnaires Table 1 and Fig. 1.
were applied with their corresponding 10-item Spanish Significant differences were found when comparing
versions. Detailed features of these instruments can be the distribution of participants according to both (WHO
found in a previous report related to this study [24]. and CDH) BMI criteria (χ2(4) = 233.20, p ≤ .001), as they
only coincided in 190 (48.10%) cases. No significant as-
Statistical analysis sociations between sex and BMI categories, neither ac-
Data were collected and analysed with the SPSS v.20 soft- cording to WHO criterion (χ2(2) = 5.01, p = .08) nor to
ware. First, descriptive statistics (means, standard devia- CDH criterion (χ2(2) = .68, p = .71) were found.
tions, frequencies, and percentages) for BMI distribution Mean outcome scores were: cognitive status 7.31 (SD =
were obtained and possible differences by sex were ex- 2.56), independent physical functioning 85.28 (SD =
plored with t-test and chi-square test. Following, the inde- 17.37) and depression 2.38 (SD = 1.87). BMI correlated
pendent associations of BMI and sex with the three significantly with all three outcome measures; yet, a rele-
outcome measures were analysed with Pearson correla- vant correlation was only observed with cognitive status
tions and t-tests, respectively. To explore the sensitivity of (r = +.32, p ≤ .001). Men scored significantly higher than
criteria for the outcome, first a series of one-way analyses women in independent functioning (p ≤ .01) and lower
of variance (ANOVAs) was run, followed by analyses of in depression (p ≤ .001); they did not score significantly
covariance (ANCOVAs) adjusting by sex and age. Finally, higher in cognitive status (p = .50).
two-way ANOVAs explored the level of BMI range cri- Regarding BMI criteria, no extreme values were found
teria x sex interaction on the three outcome measures. for any outcome measure and significant differences
were found using either WHO or CDH criterion; yet,
Results the post-hoc tests showed distinct patterns. Regarding
The final sample included 395 participants, 283 (71.6%) cognitive status and depression, WHO criteria suggest
women and 112 (24.58%) men. Mean age was 74.68 that overweight is a favourable factor in older adults,
(SD = 8.50, range: 60–98) and mean BMI was 27.68 while CDH criteria suggest underweight is disfavorable.

Table 1 Sample Body Mass Index Distribution

Total Male Female
N = 395 n = 112 n = 283
WHO CDH WHO CDH WHO CDH
n (%) n (%) n (%) n (%) n (%) n (%)
Underweight 10 (2.5) 81 (20.5) 0 (0) 20 (17.9) 10 (3.5) 61 (21.6)
Normal weight 127 (32.2) 190 (48.1) 41 (36.6) 56 (50.0) 86 (30.4) 134 (47.3)
Overweight 258 (65.3) 124 (31.4) 71 (63.4) 36 (32.1) 187 (66.1) 88 (31.1)
BMI Body Mass Index
WHO World Health Organization Body Mass Index Criterion
CDH United States National Research Council Committee on Diet and Health Body Mass Index Criterion
Estrella-Castillo and Gómez-de-Regil BMC Geriatrics (2019) 19:339 Page 4 of 8

Fig. 1 Histograms of BMI distribution according to WHO and CDH criteria

WHO criteria coincided with CDH criteria about inde- between them. CDH criteria found a poorer condition of
pendent functioning; underweight older adults had a older people with underweight as they have lower cogni-
poorer performance in comparison to normal- and over- tive and independent functioning and more depression;
weight older adults, who showed no significant differences older people with overweight were in better conditions
Estrella-Castillo and Gómez-de-Regil BMC Geriatrics (2019) 19:339 Page 5 of 8

than older people with normal weight, though differences double if considering the CDH criteria. Furthermore, the
were not significant. WHO criteria found a better func- CDH criteria displayed a distribution wherein half of the
tioning in older people with overweight; particularly re- sample had a normal weight range. These differences in
garding cognitive status and depression. The associations distribution patterns, in concurrence with previous re-
of BMI (WHO and CDH criteria) with the three outcome search [5], bring into question the adequacy of the com-
measures remained significant even after adjusting by sex. mon practice of using the WHO criteria to classify
When adjusting by age, the associations were still signifi- normal BMI in older adults. The accuracy of BMI seems
cant for cognitive status and independent physical func- to diminish with age, as body composition changes in-
tioning, but not for depression. Table 2 summarizes the crease adiposity and sarcopenia (i.e. decreased muscle
results. mass) [25]. Valid, reliable and economical assessments
The interaction of WHO BMI criteria with sex was of BMI, with ranges adapted by age, are needed [5, 26].
not significant for any of the studied outcome measures. Analyses of the association of BMI criteria with cogni-
Yet, CDH BMI criteria seemed more sensible to differ- tive functioning, physical functioning and depression re-
ences as its interaction with sex found significant results vealed similar though not equivalent patterns.
for cognitive status (F(2,389) = 4.52, p ≤ .01, η2 = .023, Considering the WHO BMI criteria, overweight seems a
power = 0.769) and independent functioning (F(2,389) = protective factor. Results from some studies, mostly rely-
3.86, p ≤ .05, η2 = .019, power = 0.698). Underweight is ing on the WHO BMI criteria, suggest that overweight is
disfavorable for cognitive status and independent func- a protective rather than a risk factor (at least for mortal-
tioning, particularly in women (Fig. 2). There is a trend ity) in older people [27]. Yet, it has been questioned
for improvement as BMI goes from underweight to nor- whether this BMI paradox just reflects the WHO crite-
mal weight. Yet, regarding overweight, this seems ria’s low sensitivity for this segment of the population
favourable in women but not in men. No significant in- [25, 26]. Classifying sample by the CDH BMI criteria,
teractions were found for depression. adapted by age range, significant results point to the op-
posite direction; that is, underweight is disfavorable in
Discussion older people. This concurs with studies reporting low
This study aimed at comparing, in a sample of Mexican BMI to be disfavorable in older people, and highly asso-
older people, BMI distribution according to two alterna- ciated with infections, hospitalizations and predicting
tive ranges as proposed by the WHO and the CDH. Re- mortality [28, 29]. Also, a rapid and unintentional weight
sults showed that having the WHO criteria a lower loss may reflect underlying illness, social deprivation, de-
threshold for what is to be considered a normal weight mentia or depression [28].
in comparison to the CDH criteria; it classified more After the age of 60, average body weight and muscle
than half the participants as overweight, that is, the mass tend to decrease. As physical activity and energy

Table 2 Differences in Cognitive Status, Independent Physical Functioning and Depression Scores According to WHO- and CDH
Body Mass Index Criteria
Cognitive status Independent physical functioning Depression
Mean (SD) Mean (SD) Mean (SD)
WHO CDH WHO CDH WHO CDH
Underweight (U) 4.50 (2.84) 5.72 (2.77) 55.00 (15.99) 75.99 (20.86) 3.90 (2.28) 3.13 (2.34)
Normal weight (N) 6.50 (2.85) 7.62 (2.39) 83.43 (18.73) 86.63 (16.37) 2.74 (2.10) 2.24 (1.69)
Overweight (O) 7.81 (2.22) 7.86 (2.28) 87.36 (15.48) 89.27 (13.98) 2.14 (1.68) 2.10 (1.68)
F(2,392) 18.96*** 21.69*** 19.45*** 16.68*** 8.04*** 8.63***
Power 1.000 1.0000 1.000 0.999 0.909 0.970
Post-hoc U < N* U < N*** U < N*** U < N*** U>N U > N***
U < O*** U < O*** U < O*** U < O*** U > O** U > O***
N < O*** N<O N<O N<O N > O** N>O
Controlling by Sex
F(2,392) 18.85*** 21.49*** 18.24*** 16.37*** 7.88*** 8.34***
Controlling by Age
F(2,392) 7.70*** 10.09*** 9.39*** 5.26** 1.75 2.26
BMI: Body Mass Index
WHO World Health Organization Body Mass Index Criterion
CDH United States National Research Council Committee on Diet and Health Body Mass Index Criterion
*p ≤ .05, **p ≤ .01, ***p ≤ .001
Estrella-Castillo and Gómez-de-Regil BMC Geriatrics (2019) 19:339 Page 6 of 8

Fig. 2 Graphic distribution of the Significant Interactions of CDH criteria with Sex on Cognitive Status and Independent Functioning

expenditure also decrease there is a tendency to fat accu- overweight and obese older people [36] our results concur
mulation and fat redistribution [30]. Here, underweight with those finding lower BMI coinciding with a worse cog-
older people showed a disadvantageous performance, while nitive status [37]. Regarding physical functioning, studies
in other studies overweight older people showed a more tend to support that high BMI values are associated with
favourable status [27]. However, one must be cautious; greater functional impediments [38]; yet, it has also been
obesity in older people is a common and serious matter of found that both, low and high BMI are related to a greater
concern not to be overlooked. Not only can obesity lead to risk of functional impairment [39]. The present results
adverse health consequences and impair quality of life, but found poorer physical functioning in underweight older
also exacerbate the age-related decline in physical function people following the CDH criteria. Depressive symptoms in
and lead to frailty, disability and autonomy limitations [29, older adults seem less likely to occur in overweight/obese
31–33]. Treatment for obesity in older persons is contro- older people [40], and that is the case in our study if the
versial, mainly to the misinterpretation that it may not be WHO criterion is used. If the CDH criterion is used, under-
as harmful in older adults as it is in younger people, and weight older people seem more likely to report depressive
the concern about the potential adverse effects of weight symptoms, and that coincides with previous findings, par-
loss in this population [28, 31, 33–35]. Even small amounts ticularly in men [40]. Discrepancies in findings might be
of voluntary weight loss (between 5 and 10% of initial body due to the use of diverse measures for body composition,
weight) along with a healthy lifestyle may benefit older cognition, functioning, and depressive symptoms, and the
people [32]. Weight loss in overweight/obese older people fact that these outcome measures have not been previously
can improve risk factors, fat loss can ameliorate certain studied together.
catabolic conditions of aging through impacting muscle Regardless of BMI criteria, the group of underweight
protein synthesis and breakdown and lighter weight may older people had a disadvantageous outcome on all three
also ease the mechanical burden on weak joints and measures in comparison to the other groups. Further-
muscle, thus improving mobility [28]. Interventions aiming more, results showed that considering its interaction
at voluntary weight-loss in obese older people must follow with sex, underweight is disadvantageous for all, whereas
a combination of exercise and modest calorie restriction for overweight is favourable in women but disfavorable in
reducing intra-abdominal fat mass while muscle mass and men. These results evidence that a criterion overlooking
strength are preserved [30, 31, 33, 35]. Moreover, interven- age and sex differences in BMI may bias research find-
tions must consider comorbidities, polypharmacy, limita- ings and perhaps explain the so-called obesity paradox
tion of autonomy, and social issues with a focus on the in older adults. More complex models including covari-
underlying medical problems, functional status and living ates that might influence outcome, such as educational
environments [34]. level, regular cognitive stimulation, comorbidities, medi-
Cognitive status, independent physical functioning, and cation intake and mental health history should be con-
depression are three important outcome measures in older sidered to support or disclaim these results.
adults that have been found related to BMI. Although some Besides, underweight women stand out as the more vul-
studies have found a poorer cognitive performance in the nerable group regarding cognitive status and independent
Estrella-Castillo and Gómez-de-Regil BMC Geriatrics (2019) 19:339 Page 7 of 8

physical functioning. Nutritional interventions must aim Conclusions

at helping older people to gain weight up to normal status In this study, the CDH seemed a more sensitive BMI cri-
(rather than reaching overweight) but considering a more terion than the WHO’s and could be recommended.
flexible cut-off point such as suggested by the CDH. That CDH criteria not only showed a more sensible distribu-
is, a healthy BMI in older people must range between 23 tion in BMI but also found significant differences in the
and 28 in people aged 55 to 65, and between 24 and 29 in selected outcome measures and some significant interac-
people aged 66 or older. Furthermore, priorities for inter- tions with sex. Underweight in older adults was related
vention should be given to those at highest risk, with the to decremented cognition, less independent physical
primary focus on reducing the risk profile rather than functioning, and more depression. Overweight seemed
weight loss per se [4]. favourable for women but disfavorable for men.
It must be underscored that more weight does not
Abbreviations
equal better nutrition or good health. Given the varying ANOVA: Analysis of variance; BMI: Body Mass Index; CDH: The United States
contributions of bone mass, muscle mass and fluid to National Research Council Committee on Diet and Health; GDS: Geriatric
body weight, relying exclusively on BMI to classify indi- Depression Scale; SPMSQ: Short Portable Mental State Questionnaire;
WHO: World Health Organization
viduals may result in misclassification. Anthropometric
data for the potential development of reference data or Acknowledgements
standards should cover at least weight and height, plus Authors thank the State Offices in Yucatan of the IMSS (Instituto Mexicano
del Seguro Social) and the ISSSTE (Instituto de Seguridad y Servicios Sociales
age, sex, race, socioeconomic status, presence of dis- de los Trabajadores del al Servicio del Estado) and the retirement home
ease, and smoking habits [4]. Relying on convenience “Brunet Celarain” for all the facilities to perform this study, and to all those
sampling limits the generalization of results as the se- who kindly took part as participants.
lected group may not be comparable to others, such as
Authors’ contributions
older adults healthy and living independently. More- D.E. contributed to the conceptualization and design of the study. L.G.
over, when studying BMI in older adults it would be recorded, analyzed and interpreted the data. D.E. and L.G. wrote the
manuscript and approved the final version.
worth exploring possible differences due to receiving
care from others, either at home or in care centres, and Funding
observing its evolution through time. As sex and age No funding was received.
were recorded, their role as possible confounders was
Availability of data and materials
analysed; although the significance of most results was The datasets used and/or analysed during the current study are available
confirmed, only when adjusting by age, the association from the corresponding author on reasonable request.
was no longer significant for depression. Further re-
Ethics approval and consent to participate
search must also consider the inclusion of other pos- Authorization and ethical approval to perform this cross-sectional study were
sible confounders such as disease status, smoking obtained from the Research and Ethics committee of the School of Medicine
status, alcohol intake, physical activity, socioeconomic and Rehabilitation of the Autonomous University of Yucatan. Written in-
formed consent was obtained from each participant before any data was
status and education for a better understanding of the collected.
processes regulating the associations of BMI with
outcome. Consent for publication
Not applicable.
Despite its limitations, this study showed that when
assessing BMI in older people, a criterion adapted by age Competing interests
must be preferred. It seems that the WHO criteria over- The authors declare that they have no competing interests.
shadow a problem in the older population, namely that
Author details
losing weight is in fact unfavorable, leading to a lower 1
Universidad Autónoma de Yucatán. Facultad de Medicina. Licenciatura en
BMI. The CDH criteria are much more sensitive to that Rehabilitación, Avenida Itzáes No. 498 x 59 y 59A. Colonia Centro. Mérida,
problem. Furthermore, the fact that WHO cut-off points 97000 Merida, Yucatán, Mexico. 2Hospital Regional de Alta Especialidad de la
Península de Yucatán, Calle 7, No. 433 por 20 y 22, Fraccionamiento
are more restrictive may help explaining why various Altabrisa. Mérida, 97130 Merida, Yucatán, Mexico.
studies using this criterion found overweight to be
favourable in older people. The use of CDH cut-off Received: 21 December 2018 Accepted: 21 November 2019

points showed that overweight is not a protective, nei-

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