The number of elderly people is increasing in less-developed countries. Although nutritional deficiencies and infectious diseases are generally more prevalent in resource-poor countries, the health and nutritional status of the elderly in South America in general, and in Ecuador, in particular, remains largely unstudied. The objective of the present study was to assess the nutritional, immunological and health status of elderly Ecuadorians. A cross-sectional study was conducted to evaluate a sample of elderly Ecuadorians with 24 h dietary recalls, biochemical and anthropometric measurements, delayed type hypersensitivity skin response and a health questionnaire. The 145 elders who enrolled had a mean age of 74·3 (sd 6·9) years. Of the subjects, 52 % exhibited BMI ≥25 kg/m2, whereas 9·1 % had BMI ≤20 kg/m2. Means of dietary intakes were below recommendations for most nutrients; exceptions were carbohydrate, fat, Fe and Se. Serum nutrient levels indicated that 50, 44, 43, 19 and 18 % of participants had deficiencies of Zn, Fe, vitamins B12 and D, and folate, respectively. The mean number of positive responses to seven recall antigens was 2·1 (sd 1·7) with an induration diameter of 9·9 (sd 7) mm, which are substantially lower than those reported for elders in developed countries. During the previous 6 months, 54 and 21 % of subjects reported at least one episode of respiratory infection or diarrhoea, respectively. Of these, 47 % sought care at a hospital or from a physician and 96 % from a relative or friend. In conclusion, while few elderly Ecuadorians were underweight, obesity was common. Micronutrient deficiencies were prevalent and may contribute to reduced immunological responses in this population.