Evaluate the longitudinal association between BP control and the use of antihypertensive classes with arterial stiffness (AS) in Brazilian adults.

This study included 1830 participants with arterial hypertension (1092 participants with controlled BP and 738 participants with uncontrolled BP) from the Longitudinal Study of Adult Health (ELSA-Brasil). AS was assessed by pulse wave velocity (PWV) and pulse pressure (PP) at baseline and repeated after approximately 9 years. Associations between AS and BP control and the use of antihypertensives, diuretics, angiotensin-converting enzyme inhibitors (ACEI), AT1 receptor blockers (ARB), calcium channel blockers (CCB), and beta blockers (in the population with controlled BP), at baseline were investigated using linear mixed-effects models.

Uncontrolled BP was associated with worse PWV and PP trajectory, respectively (β = 0.026 [0.008 to 0.036] / β = 0.273 [0.216 to 0.330]). Among the participants with controlled BP, using CCB (β = 0.031 [0.011 to 0.051]) was associated with a worse PWV trajectory, compared to not using this class and this combination, respectively.

BP control, regardless of the class of antihypertensive used is associated with a better AS trajectory, as assessed by PWV and PP. Among participants with controlled BP, the use of BCC, compared to not using this class, seems to be worse for the trajectory of PWV in individuals with arterial hypertension without cardiovascular disease. Further studies are needed to assess whether this effect results in a better prognosis for patients with arterial hypertension.

While headache disorders are linked to low physical activity levels, the impact of depression on this relationship is unclear.

To assess how single and comorbid diagnoses of migraine and tension-type headache (TTH) interact with depression and leisure-time physical activity (LTPA) levels in The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

In this cross-sectional analysis based on the ELSA-Brasil baseline data, the relationship of migraine, TTH (both assessed with the International Classification of Headache Disorders, Second Edition), and depression (assessed with the Clinical Interview Schedule-Revised) with LTPA levels (International Physical Activity Questionnaire) was investigated by employing linear regression models. Models were adjusted for sociodemographic, lifestyle, and clinical covariates, and interaction terms were created to examine additive effects of comorbid conditions.

Among 14,088 participants, 54.4% (7668/14,088) were female, prevalence rates were: TTH = 39.6% (5573/14,088), migraine = 27.0% (3806/14,088), depression = 0.7% (94/14,088), depression + TTH = 1.1% (148/14,088), and depression + migraine = 2.5% (356/14,088). The mean (standard deviation) LTPA levels across the groups were: no headache + no depression = 148.7 (183.0) min/week, TTH = 133.5 (170.1) min/week, migraine = 110.3 (154.8) min/week, depression = 76.5 (146.3) min/week, depression + TTH = 84.5 (127.7) min/week, and depression + migraine = 64.3 (123.2) min/week. Negative associations were found for depression (β = -55.1, 95% confidence interval [CI] -93.6 to -17.0; p = 0.005), migraine (β = -24.7, 95% CI -33.2 to -15.4; p < 0.001), and TTH (β = -15.5, 95% CI -23.1 to -7.6; p < 0.001) with LTPA. No interaction effect was observed for depression + TTH (β = 36.0, 95% CI -12.6 to 84.6; p = 0.147) and depression + migraine (β = 31.7, 95% CI -11.3 to 74.7; p = 0.149), indicating no additive effect of comorbid conditions on LTPA levels. After adjusting for headache attack frequency, only depression + migraine remained negatively associated with LTPA (β = -38.7, 95% CI -71.6 to -5.8; p = 0.021).

Headache disorders and depression were independently and inversely associated with LTPA, with the strongest effects seen in depression alone or comorbid with migraine.

Low-density lipoproteins (LDL) comprise a pool of particles with different densities that may have variable impact on atherogenesis. Studies suggest that obese individuals with elevated body mass index (BMI) and waist circumference (WC) have increased small and dense LDL subfractions (sdLDL-c). It is unclear if diabetes (T2D) and insulin resistance (IR) may modify this association. We included 4,111 (50.4 ± 8.6 years of age, 45.5% men) individuals with neither prior cardiovascular disease nor use of lipid-lowering medications. Total LDL-c and its subfractions (LDL1-c, LDL2-c, LDL3-c, and LDL4-c) were measured by vertical zonal ultracentrifugation. We considered the subfractions LDL1-c and LDL2-c as large buoyant LDL (lbLDL-c) and the subfractions LDL3-c and LDL4-c as sdLDL-c. We analyzed the association between LDL-c subclasses, BMI and WC using linear regression analysis and stratified by the presence of T2D and IR. For sdLDL-c, a direct association with hypertension, T2D, fasting plasma glucose, total cholesterol, LDL-c, and triglycerides was observed. In multivariate analysis, after adjustment for age, sex, race and triglycerides, the strong association of sdLDL-c with BMI (β 95% CI 0.16 (0,13-0,19)) and WC (β 95% CI 0.22 (0.19-0.26)) persisted. After stratification, the association of sdLDL-c and WC was present only in those with insulin resistance or diabetes. BMI showed a smaller impact than WC on this association. WC and BMI were strongly associated with sdLDL-c subfractions. Further, this association was modified by diabetes and insulin resistance status.

Heart failure (HF) has a major impact on public health. HF staging helps capture preclinical disease and its progression to advanced stages. There are scarce data on HF staging from longitudinal studies in Latin America. This study aimed to determine the prevalence and mortality of HF stages in a Brazilian adult cohort of participants 60 years old and over.

The ELSA-Brasil (Brazilian Longitudinal Study of Adult Health) multicentric cohort comprises 15 105 adults. From 2008 to 2010, ELSA carried out interviews and clinical, laboratory, and cardiovascular tests. In this analysis, we included participants 60 years old and over who had an echocardiogram performed at baseline visit and additional information regarding risk factors and functional capacity.

There were 2356 participants (65±4 years; 53% women) with baseline echocardiogram. Of these, 504 (21%) participants were considered at low risk for developing HF (stage 0). Prevalence of HF was 1026 (44%) for stage A (at risk for HF), 557 (24%) for stage B (pre-HF), and 269 (11%) for stage C (symptomatic HF), with different distribution between sexes (P<0.001). Multivariable risk-adjusted model for all-cause mortality over a median follow-up of 12 years, found 6%, 12%, 18%, and 27% for stages 0, A, B, and C, respectively, with hazard ratios of 1.82 [95% CI, 1.2-2.7], 2.52 [95% CI, 1.7-3.8], and 4.29 [95% CI, 2.8-6.6], using as reference stage 0.

The high prevalence of symptomatic, and preclinical HF in older adults and the increased mortality with disease progression may be responsible for an elevated public health burden. This information is critical for understanding and planning health policies for older adults in middle-income countries.

BackgroundHearing loss (HL) of moderate or higher grades is common in older adults with increasing prevalence as people age, rising from 12% at the age of 60 years to over 58% at 90 years. HL in midlife is one of the main potentially modifiable risk factors for dementia. It is estimated that 7% of dementia cases globally could be avoided if this risk factor was eliminated. However, much of the research conducted has been in high-income countries even though low- and middle-income countries have the highest prevalence of dementia.ObjectiveTo study the association between HL and cognitive decline during eight years of follow-up in a Brazilian sample.MethodsParticipants from the São Paulo center of the Brazilian Longitudinal Study of Adult Health were evaluated in three study waves (2008-10, 2012-14, and 2017-19). HL was defined as pure-tone audiometry above 25 dB in the better ear. Cognitive performance was evaluated with six tests related to memory, verbal fluency, and trail-making tests. A global cognitive z-score was derived from these tests. The association between HL and cognitive decline was evaluated with linear mixed-effects models adjusted for sociodemographic, lifestyle, and clinical factors.ResultsOf 805 participants (mean age 51 ± 9 years, 52% women, 60% White), 62 had HL. During follow-up, HL was associated with faster global cognitive decline (β = -0.012, 95% CI = -0.023; 0.000, p = 0.039).ConclusionsHL was significantly associated with a faster rate of global cognitive decline after a median follow-up of eight years in a sample of middle-income country.

Understanding the relationship between antithyroperoxidase antibodies (TPOAb) and carotid intima-media thickness (cIMT) could provide insights into the mechanisms linking thyroid autoimmunity and cardiovascular disease. We aimed to explore the association of multiple categories of TPOAb with the increased cIMT at baseline and at follow-up in participants from the ELSA-Brasil Study.

This prospective cohort study analyzed data from 9,264 participants (51.5 ± 8.9 years old, 55.9% women) without a history of cardiovascular disease. Fasting serum TPOAb levels were determined. Values of cIMT equal to or above one deviation standard of the sample's mean were classified as increased cIMT at baseline. The increased cIMT after the 8-year follow-up was calculated after excluding participants with increased cIMT at baseline. Multivariate analyses were done using binary logistic and Poisson regression models.

The increased cIMT was prevalent in 14.3% of the participants at baseline and its development occurred in 16.8% participants during the cohort. After adjustment for all confounder variables, TPOAb detectability (OR = 1.84, 95%CI = 1.21-2.79), and low detectable (OR = 1.81, 95%CI = 1.18-2.75), high detectable (OR = 2.01, 95%CI = 1.29-3.11) and positive (OR = 1.70, 95%CI = 1.07-2.70) TPOAb were positively associated with increased cIMT at baseline. The associations of low and high detectable TPOAb and increased cIMT at baseline were consistent when excluding those with thyroid dysfunction. There was no statistically significant association between TPOAb levels and increased cIMT at follow-up (p > 0.05), neither for all sample nor for euthyroid individuals.

Different levels of TPOAb, including its detectability, were associated with increased cIMT at baseline in the studied sample. We highlight that may be relevant to consider the levels of TPOAb detectability as possible marker of increased cardiovascular risk.

Previous research indicates a higher prevalence of glaucoma in Black individuals of African descent. However, the association between race and glaucoma in Brazil's multiracial population remains underexplored. This study examines this association and seeks to identify preventable factors potentially influencing prevalence differences among racial groups in Brazil, should such difference be found.

Employing a cross-sectional design, data were analyzed from 10,696 participants in the multicenter Brazilian Longitudinal Study of Adult Health (2008-2010) who self-identified their race as White, Black, mixed race (pardo), Asian, or Indigenous and completed an ophthalmological questionnaire including their self-reported glaucoma status (yes or no). Poisson regression was used to estimate prevalence ratios (PRs) with robust SEs and adjustments for sociodemographic characteristics and the presence of diabetes, hypertension, and obesity.

The prevalence of glaucoma was 5.8% in Black (86/1483), 3.8% in mixed race (101/2688), 3.8% in indigenous (4/106), 3.5% in Asian (10/288), and 2.4% in White (145/6131) populations. Compared with Whites, Blacks and mixed-race individuals were younger. Age-adjusted prevalence was 175% higher in Black individuals (PR=2.75, 95% confidence interval [CI]: 2.12, 3.56) and 85% higher in mixed-race individuals (PR=1.85, 95% CI: 1.44, 2.36) compared with Whites. The strength of these associations was reduced in models including the comorbidities of obesity, hypertension, and diabetes, which are more prevalent in Black and mixed-race individuals.

Our results reveal a higher prevalence of self-reported glaucoma in non-White groups, especially among Black and mixed-race individuals. Although causality cannot be conclusively established, our data suggest that the increased prevalence of glaucoma in these groups, compared with their White peers, is partially influenced by preventable health conditions.

Although movement behaviors are linked to mortality risk, few studies investigated the associations between daily steps and movement behaviors and all-cause mortality in low- and middle-income countries.

We investigated associations of step count, total activity volume, moderate-and-vigorous physical activity (MVPA), light-intensity physical activity (LPA), sedentary behavior, sleep duration, and various isotemporal substitutions with all-cause mortality in middle-aged and older Brazilian adults.

ELSA-Brasil cohort study 3rd wave (2017-2019) participants wore an ActiGraph wGT3X-BT on the waist for seven days and completed a sleep diary. We followed participants to January 1st, 2024. Using Cox regression models, we estimated adjusted hazard ratios (HR). Using compositional data analysis, we examined changes in mortality associated with isotemporal substitutions.

Overall, 8832 participants (55.8 % female, age 59.2 ± 8.6) were followed for a median of 5.43 person-years (total 46,793.2), with 216 deaths. All behaviors except sleep showed curvilinear associations with mortality. Mortality declined with a plateauing effect at a daily total activity volume of 15.9 millii-g (HR 0.36, reference 7.83), 7300 steps (HR 0.48, reference 3881), 49.4 MVPA minutes (HR 0.28, reference 11.34), and 245.8 LPA minutes (HR 0.67, reference 135.6). Engaging in less than 842 sedentary behavior minutes/day was linked with an HR of 0.67. Reallocating 10 daily minutes from other behaviors to MVPA showed a consistent 10 % decrease in mortality.

In Brazilian adults, step count, total activity volume, MVPA, LPA, and sedentary behavior were non-linearly associated with lower mortality. Reallocating any time from other behaviors to MVPA predicted lower mortality.

Using data from 12,987 participants of the second visit of ELSA-Brasil (2012-2014), we investigated whether race/skin color (white, mixed-race, black) modifies the association of intergenerational educational mobility with life satisfaction and average per capita income. Intergenerational educational mobility was assessed by comparing maternal schooling with that of participants. The Satisfaction with Life Scale (satisfied versus dissatisfied) was used to assess satisfaction with life. The prevalence of dissatisfaction with life was higher in black (13.5%) and mixed-race people (12.4%) than in white ones (9.2%). After adjusting for age, sex, marital status, and research center, upward educational mobility was associated with 32% odds (OR = 0.68; 95%CI: 0.53-0.86) of lower levels of dissatisfaction with life when compared to the stable-low trajectory, but this association only occurred for white people. The stable-high trajectory was associated with 31% (OR = 0.69; 95%CI: 0.56-0.86) and 29% (OR = 0.71; 95%CI: 0.54-0.95) odds of lower rates of dissatisfaction with life in white and mixed-race people, respectively. Black individuals showed no association between social mobility and life satisfaction. Consistent with these findings, upward and stable-high educational trajectories were associated with higher per capita family income in white people and lower income in black individuals. Results reinforce that structural racism reduces the benefits of educational mobility regarding life satisfaction and income in black and mixed-race people when compared to the benefits for white people.

This study analyzed the cross-sectional association of elevated concentrations of low-density lipoprotein particles (LDLp) and triglyceride-rich lipoprotein particles (TRLp) with carotid artery plaque (CAP) in the ELSA-Brasil cohort.

Data from 3801 participants (median age: 50.0 years [interquartile range 44.0-57.0], 54.3% women) with no prior history of cardiovascular disease nor use of lipid-lowering medications were analyzed. CAP was assessed by ultrasonography, while nuclear magnetic resonance (NMR) spectroscopy was used to measure LDLp and TRLp concentrations according to size. Poisson regression models characterized the association of elevated lipid concentrations (≥1 SD above the mean) with CAP, adjusted for sociodemographic variables, cardiovascular risk factors, and for the concentration of high-density lipoprotein particles (HDLp), LDLp, and TRLp.

The frequency of CAP was 33.9% (n = 1,287). Elevated concentrations of total TRLp (prevalence ratio [PR]:1.05 [95% CI:1.01-1.10]) and small-sized TRLp (PR:1.23 [95% CI:1.11-1.36]) were associated with CAP, but lost significance after adjustment for LDLp. Elevated LDLp concentration was associated with CAP in total (PR:1.10 [95% CI:1.05-1.15]) and in all the different sizes (large [PR:1.09], medium [PR:1.11] and small [PR:1.09]), regardless of TRLp. When both LDLp and TRLp were simultaneously included in a dedicated model, only LDLp remained associated with CAP (PR:1.11 [95% CI: 1.06-1.16]). By particle size, elevated small TRLp and elevated LDLp in all sizes were associated with CAP even when mutually adjusted.

The elevated concentration of small TRLp seems to portend an incremental residual likelihood of prevalent CAP beyond LDLp, whereas the association of LDLp with CAP remained consistent beyond classical risk factors and NMR-assessed HDLp and TRLp concentration.

Fruit- and vegetable-rich diets may protect against metabolic syndrome (MetS), partly due to their high polyphenol content.

This study examined the association between dietary polyphenol intake, MetS risk, and cardiometabolic factors in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

A total of 6387 participants (mean age 49.8 y, 65% female) were included. Food intake was assessed via a semiquantitative Food Frequency Questionnaire with polyphenol content from the Phenol-Explorer database. MetS was defined using the Joint Interim Statement. Logistic regressions assessed associations between polyphenol intake tertiles and cardiometabolic risk factors, as well as the odds of MetS during the follow-up period.

During a median of 8.19 y follow-up, 2031 cases of MetS occurred. The second and third tertiles of total polyphenol intake were associated with 22% and 23% lower odds of MetS, respectively, after adjusting for sociodemographic, lifestyle, and dietary factors (T2 vs. T1, odds ratio [OR] 0.78 [95% confidence interval {CI}: 0.68, 0.90]; T3 vs. T1, OR 0.77 [0.66, 0.90]). Inverse associations were also found between phenolic acids, lignans, stilbenes, other polyphenols, and the odds of MetS. Although no significant link was observed for total flavonoids, flavan-3-ols showed inverse associations with MetS (monomers: T3 vs. T1, OR 0.92 [0.80, 0.94]; dimers to polymers: T3 vs. T1, OR 0.82 [0.70, 0.96]). Total polyphenol intake was also inversely associated with waist-hip ratio, diastolic blood pressure, systolic blood pressure, HOMA-IR, triglycerides, and C-reactive protein, and positively associated with total cholesterol, LDL cholesterol, and HDL cholesterol.

Higher intakes of dietary polyphenols, particularly phenolic acids, lignans, stilbenes, other polyphenols, and flavan-3-ols, were inversely associated with the odds of MetS and its components. These findings suggest that promoting polyphenol-rich diets could be a valuable strategy in reducing cardiometabolic risk and preventing MetS in the population, potentially informing dietary guidelines and public health interventions.

Hand grip strength (HGS) may represent an epidemiologically relevant alternative as an initial screening tool for sarcopenia and sarcopenic obesity. However, no study evaluated the performance capacity of HGS compared to other biomarkers in discriminating these conditions in adults.

The study aimed to evaluate the performance of HGS as discriminator of sarcopenia and sarcopenic obesity, compared to urinary biomarkers of creatinine and potassium in 24 h for Brazilian adults.

Cross-sectional study. Women (n = 5431) and men (n = 6351) aged 38-79 years who participated in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) at second follow-up of the cohort (2012-2014). The area under the receiver operating characteristic curve (AUC) and the respective 95% confidence intervals were calculated for men and women in different age groups to assess the performance of HGS as a discriminator of sarcopenia and sarcopenic obesity, compared to the biomarkers of potassium and creatinine in urine in 24 h. The outcomes were classified based on the skeletal muscle mass index (BMI/height2) and fat percentage, estimated from the bioimpedance analysis data. Sensitivity, specificity and Brier score were calculated for each estimated HGS cut-off point.

It can be observed that 18.20% (15.51% women; 21.34% men) of the population showed a decline in skeletal muscle mass (sarcopenia). Of this total, 11.61% (10.52% women; 12.89% men) presented the isolated outcome of sarcopenia and 6.59% (4.99% women; 8.45% men) of sarcopenic obesity. The HGS areas under the ROC Curve ranged from 0.54 (CI = 0.493-0.596) to 0.76 (CI = 0.650-0.878) according to sex and age group. HGS performance compared to biomarkers was significantly higher in virtually all strata and outcomes analysed. The cut-off points that demonstrated greater accuracy and better performance in outcome discrimination were ≤ 42, ≤ 41, ≤ 38 and ≤ 36 kgf among males aged 38-44 years, 45-54 years, 55-64 years and 65-79 years, respectively. For women in the same age groups, HGS cut-offs were ≤ 26, ≤ 23, ≤ 23 and ≤ 21 kgf, respectively.

The results suggest that HGS is a good discriminator of sarcopenia and sarcopenic obesity, capable of achieving superior or equal performance to muscle mass biomarkers, especially in middle-aged adults.

This study investigated the association of the intersectional categories of gender-race/color with inadequate blood pressure (BP) control in Brazilian adults using antihypertensive drugs to treat hypertension. This is a cross-sectional analysis conducted with 4448 participants living with hypertension from visit 2 (2012-2014) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) undergoing pharmacological treatment. The association of the intersectional categories - White woman, Brown woman, Black woman, White man, Brown man, Black man - with inadequate BP control (systolic BP levels ≥140 mmHg and/or diastolic BP levels ≥90mmH) was estimated by the prevalence ratio (PR) and 95% confidence interval (95% CI) obtained by generalized linear models with Poisson distribution, adjusted covariates. The age-standardized prevalence of inadequate BP control ranged from 18.9% (White women) to 35.6% (Black men). After adjusting for sociodemographic characteristics, health-related behavior, health conditions, and the class number of antihypertensive medications, compared to White women, Black men (PR: 1.49 95% CI: 1.26-1.75), Brown men (PR: 1.42 95% CI: 1.18-1.72), Black women (PR: 1.36 95% CI: 1.12-1.65), and White men (PR: 1.32 95% CI: 1.09-1.60) showed poorer BP control. Results corroborate a higher prevalence of inadequate BP control in Black and Brown men. Furthermore, this intersectional approach evidenced that the prevalence of inadequate BP control in Black women is higher than that in White men, when compared to White women. Findings highlight that, for the development of more equitable BP control strategies, one must consider the specificities of socially marginalized intersectional groups, especially Black men and women.

Folate and vitamin B12 are vitamins involved in one carbon metabolism. Carotid intima-media thickness (cIMT) is a non-invasive test and an early atherosclerosis marker. The relationship between these vitamins and cIMT is not well established. This study aimed to investigate the association between baseline vitamins and cIMT changes during a median follow-up of 8 years.

Prospective cohort study involving 5061 ELSA-Brasil participants from São Paulo state aged 35-74 years at baseline. Serum folate and vitamin B12 levels and dietary intake were assessed at baseline. Ultrasound cIMT measurements were performed at baseline and wave 3. Linear mixed-effects models, adjusted for covariables, assessed the association between vitamins at baseline and changes in cIMT.

4260 participants were included; mean (SD) age was 51.4 (8.9) years and 54.5 % were women. Folate (0.02 %) and vitamin B12 (2.6 %) deficiencies were almost nonexistent. Participants in the 4th quartile of serum folate had a slower cIMT increase during 8 years of follow-up than those in the 1st quartile (1st vs. 4th quartile comparison: β (95 % CI): -0.015 (-0.026; -0.004), P: 0.006 for model 3). These findings remained the same after sensitivity analysis for overall dietary supplements and specifically multivitamins use. No association was found between vitamin B12 biomarker and the outcome. Dietary folate intake was also not associated with cIMT changes.

In this population exposed to mandatory folic acid food fortification, prevalence of vitamins deficiencies was very low. Highest quartile of serum folate seemed to slow down the increment of cIMT measurements over time.

The scope of this study was to determine the diagnostic performance of ABSI for obesity and sarcopenic obesity, compared to the results of bioimpedance analysis (BIA) and BMI, by sex and age group. It involved a cross-sectional study with 12,793 participants in the second round of ELSA-Brasil (Longitudinal Study of Adult Health in Brazil), which obtained measurements of body fat percentage using BIA and anthropometry, verifying the performance of the diagnostic tests in order to compare the indices. The results showed that for obesity in men in all three age groups, the sensitivity was below 49%. Specificity ranged from 73% to 93%, with a higher percentage in the 65 to 79 age group. The same pattern was found for women, with sensitivity lower than 42%, and specificity ranged from 85% to 92%, and was higher in older women. With respect to sarcopenic obesity, the sensitivity and specificity among men in the three age groups were 72% was 99%, respectively. Among women, sensitivity was around 95% and specificity around 70% in all age groups. ABSI, compared to BIA, showed a reduced ability to identify obesity. However, it proved to be a good marker of sarcopenic obesity.

Contemporary dietary and nutritional transitions are commonplace, but difficult to study directly. In Brazil, and Latin America, this generalized process, leading to current obesity and malnutrition problems, started more than four decades ago. Although body weight and food availability are used to measure changes, not much information on food consumption and nutrition exist. Stable isotope analysis allows for the study of modern individual diets because it reflects the proportional contribution of different foods, general dietary patterns, and the effect of metabolism. Furthermore, when samples from tissues reflecting different time points are used, it allows for the assessment of individual transitions.

To explore intra-person isotopic variation for the first time in the Southern Hemisphere for modern humans, and examine the nutritional transition reported for Brazil in the past four decades.

Stable carbon and nitrogen isotope values from 68 14C-dated bone samples (vertebra, occipital, parietal, femur) from 17 individuals born in 1963, from three cemeteries.

Data reflect chronologically ordered high intra-individual δ15N variation tracking the dietary and nutrition transition over the last few decades, while no relationship between δ13C values and time was found. Vertebrae, reflecting diets from the mid 2000s, showed lower δ15N values than other bones reflecting the mid 1980s and early 1990s.

We show how different bones capture nutritional transitions over the lifespan of modern individuals. Nitrogen isotope values were lower in recent tissues as a consequence of the changes in the agri-food industry and worldwide consumption patterns that have intensified in Latin America in the last decades.

Background/Objectives: Lowering low-density lipoprotein cholesterol (LDL-C) to <70 mg/dL is recommended for most patients with diabetes. However, clinical trials investigating subjects with diabetes who are not at high cardiovascular risk are inconclusive regarding the all-cause mortality benefit of the current target, and real-world studies suggest greater mortality. We aimed to assess the all-cause mortality at different LDL-C levels among subjects with diabetes not at high risk and to examine the potential roles of early deaths and frailty for this greater mortality. Methods: We followed 2098 such participants of the ELSA-Brasil cohort between 2008 and 2019. Results: Over 10.3 (1.4) years of follow-up, 204 (9.7%) individuals died. In the proportional hazards models, participants with LDL-C values < 100 mg/dL and <70 mg/dL had greater adjusted mortality compared to those with LDL-C 100-129 mg/dL (HR = 1.67; 95%CI 1.21-2.30 and HR = 2.27; 95%CI 1.51-3.41, respectively). Increased risk when LDL-C was <100 mg/dL was higher in those >60 years (HR = 2.12; 95%CI 1.35-3.34) and greatest for deaths due to cancer (HR = 2.55; 95%CI 1.10-5.91). Further analyses for those with LDL-C < 100 mg/dL that excluded early deaths and adjusted for the frailty phenotype (HR = 2.01; 1.19-3.41) or frailty index (HR = 1.92; 1.17-3.16) did not materially alter the results. The risk of death across the spectrum of LDL-C was U-shaped, with a nadir at 112.2 mg/dL. Conclusions: The higher risk of all-cause mortality in these subjects with LDL-C within currently recommended levels was not explained by early deaths or frailty. Given the recent decline in cardiovascular mortality and the increased risk of cancer and infections in persons with diabetes, the clinical significance of low LDL-C in diabetes requires reconsideration and the definition of LDL-C treatment targets in diabetes warrants further trial evaluation.

There is scarce data concerning the relationship between negative life events (NLEs)* and current and new depressive episodes by age.

Cross-sectional (baseline) and prospective analyses (4-year/8-year follow-ups) were performed in 15,105 civil servants in 6 cities in Brazil classified according to age strata at baseline: 1st(35-44), 2nd(45-54), 3rd(55-64), and 4th(65-74) years. The independent variable was NLEs in the last year (robbery, hospitalization, death of a relative, financial hardship, and rupture of a love relationship) collected at baseline. The dependent variable was depressive episodes assessed at baseline (current), and 4-year/8-year follow-ups (new). We built logistic (Odds Ratio[OR];95 % Confidence Interval[CI]) in the cross-sectional analysis and Poisson regression models (Relative Risk[RR], [CI]) in the prospective analysis.

Robbery, hospitalization, financial hardship, rupture of a relationship were associated with current depressive episodes concentrated in the 35-44 age range, while for new depressive episodes, the association of hospitalization, death of a relative, and financial hardship were concentrated in the 45-54 age stratum. Financial hardship was associated with current depressive episodes in all age-strata: 1st: OR, 2.77(CI, 1.83-4.19); 2nd: OR, 1.71(CI, 1.26-2.34); 3rd: OR, 1.68(CI,1.15-2.46); 4th, OR, 4.07(CI, 1.24-13.34), and new depressive episodes: 1st: RR, 1.45(CI, 1.09-1.93); 2nd RR, 1.46(CI: 1.15-1.84); 3rd: RR, 1.97(CI, 1.38-2.82). Rupture of a relationship was associated only with current depressive episode, while death of a relative only with new depressive episode.

We cannot rule out the possibility of recall bias, since NLEs` information was self-reported.

The association between NLEs with depressive episodes was concentrated in youngers.

this study aimed to identify the association between changes in Leisure-Time Physical Activity (LTPA) and Perceived Weight Gain (PWG) during the COVID-19 pandemic among participants enrolled in the Longitudinal Study of Adult Health (ELSA-Brasil).

an observational longitudinal study utilizing data from the ELSA-Brasil, Wave 3 - W3 (2017-2019), and Wave-COVID - WC (July/2020 to February/2021). LTPA was assessed using the International Physical Activity Questionnaire, collected at both time points, while PWG was evaluated through a questionnaire in WC. Statistical analyses were performed using the SPSS 21.0, with significance set at p < 0.05.

among 4402 adults (57.8 % women), after adjusting for potential confounding variables, individuals who reduced their LTPA levels to the extent of changing their classification were more likely to experience PWG - specifically, those who were moderately active in W3 and became sedentary in WC (OR = 1.5 [95 % CI, 1.2-1.9]) or had low LTPA in WC (OR = 1.6 [95 % CI, 1.2-2.1]), and those who were highly active in W3 and presented a low level of LTPA in WC (OR = 2.3 [95 % CI, 1.05-5.4]).

our findings suggest that individuals who engaged in LTPA (moderately and highly levels) during W3 but transitioned to insufficiently active or sedentary lifestyles during the WC, were more likely to experience PWG.

Background/Objectives: Avoidance of ultra-processed foods (UPFs) has been recommended to achieve a healthy diet, but whether it applies equally to all UPFs is uncertain. We evaluated individual UPF subgroups in the prediction of cardiometabolic and mental health outcomes. Methods: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is an occupational cohort study of 15,105 adults (35-74 years) recruited in 2008-2010. We followed participants up to 2018 to ascertain elevated weight and waist gains and the onset of metabolic syndrome, hypertension, metabolic dysfunction-associated steatotic liver disease, diabetes, common mental disorders, depressive episodes, and anxiety disorders. Results: In adjusted robust Poisson regression, greater overall UPF intake at the baseline predicted all studied outcomes. Various subgroups of UPF, most frequently processed meat and sweetened beverages, individually conferred a greater risk, and nearly all predicted at least one studied outcome. Considering all subgroups and outcomes, a broad pattern of overall risk was present. When subgroups not individually predictive of these outcomes were aggregated, increased risk (for a one-standard deviation change) was observed for elevated weight (RR = 1.05; 95% CI 1.01-1.11) and waist (RR = 1.05; 95% CI 1.00-1.10) gains, and for the incidence of common mental (RR = 1.06; 95% CI 1.01-1.12), and anxiety (RR = 1.09; 95% CI 1.02-1.16) disorders. Conclusions: UPFs overall and their subgroups predicted future cardiometabolic and mental health outcomes. The pattern of individual UPF subgroup associations varied across outcomes, and the aggregate of subgroups not individually predicting risk also predicted large gains in overall and central adiposity and the incidence of mental health disorders. While additional studies investigating other outcomes are needed, these findings justify avoidance of overall UPF intake in health promotion and disease prevention.

Most anaemia studies focus on children and women of childbearing age. We assessed the frequency and main aetiologies of anaemia according to sociodemographic characteristics at the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a cohort of middle-aged adults.

The primary analyses included 15,051 participants aged 35-74 years with a valid blood cell count. We built logistic models to analyse the association between socioeconomic characteristics and anaemia diagnosis. We also described the main aetiologies in a subset (n = 209) of participants with anaemia.

Anaemia was present in 3.0% (95% confidence interval [95%CI]: 2.6-3.4%) of men and 7.4% (95%CI: 6.9-8.0%) of women. The frequency of anaemia diagnosis was higher in women in all subgroups except for the oldest age stratum (65-74 years). The frequency of anaemia was particularly high in Blacks (6.0% and 15.5% in men and women, respectively). The most common causes of anaemia were iron deficiency (in women), chronic kidney disease, and chronic inflammation (in men). The frequency of unexplained anaemia was respectively 33.3% and 34.2% for men and women, and this condition was more frequent among participants of Black or Mixed races.

Anaemia was associated with age, female sex, Black race, and low socioeconomic status. Unexplained anaemia was common and more frequent in individuals of Black and Mixed races. ELSA-Brasil follow-up data may provide further insight into the relevance of unexplained anaemia in this setting.

Biological age is a construct that seeks to evaluate the biological wear and tear process of the organism that cannot be observed by chronological age. We estimate individuals' biological age based on biomarkers from multiple systems and validate it through its association with mortality from natural causes. Biological age was estimated in 12,109 participants (6621 women and 5488 men) from the first visit of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) who had valid data for the biomarkers used in the analyses. Biological age was estimated using the Klemera and Doubal method. The difference between chronological age and biological age (Δage) was computed. Cox proportional hazard models stratified by sex were used to assess whether Δage was associated with mortality risk after a median follow-up of 9.1 years. The accuracy of the models was estimated by the area under the curve (AUC). Δage had equal mean for men and women, with greater variability for men. Cox models showed that every 1-year increase in Δage was associated with increased mortality in men (HR (95% CI) 1.21; 1.17-1.25) and women (HR (95% CI) 1.24; 1.15-1.34), independently of chronological age. Results of the AUC demonstrated that the predictive power of models that only included chronological age (AUC chronological age = 0.7396) or Δage (AUC Δage = 0.6842) was lower than those that included both, chronological age and Δage (AUC chronological age + Δage = 0.802), in men. This difference was not observed in women. We demonstrate that biological age is strongly related to mortality in both genders and is a valid predictor of death in Brazilian adults, especially among men.

Dementia is a fast-growing public health problem. This study examined the association of physical activity and estimated cardiorespiratory fitness (eCRF) with the risk of cognitive impairment.

Multicentric, prospective cohort study.

We analyzed 10,121 participants of the ELSA-Brasil study. We assessed leisure-time physical activity using the long version of the IPAQ questionnaire and defined moderate-to-vigorous physical activity (MVPA) per week. We applied a non-exercise prediction equation to estimate eCRF and classified participants as unfit (lowest tertile) and fit. Leisure-time MVPA and eCRF were measured at baseline and follow-up. Incident cognitive impairment was based on memory, language, and executive function assessed at baseline and follow-up.

During a median of 8.1 (7.8-8.5) years of follow-up, we identified 396 (3.9 %) incident cases of cognitive impairment. There was an inverse, non-linear association between the incidence of cognitive impairment and both leisure time MVPA and eCRF. Low eCRF (IRR: 1.29; 95%CI: 1.02, 1.64) and low MVPA (IRR: 1.40; 1.09, 1.82) were independently associated with an increased incidence. Increasing 1 MET in eCRF from baseline to follow-up visit was associated with a lower incidence of cognitive impairment (IRR: 0.80; 95%CI: 0.71, 0.91), while a decrease of 13.7 min per day in leisure time MVPA is associated with an increased incidence (IRR: 1.16; 95%CI: 1.01, 1.33) of cognitive impairment. These associations remained statistically significant in adults under 65 but not in older adults.

Low eCRF and leisure time MVPA are strong and independent predictors of incident cognitive impairment especially in middle-aged adults.

We investigated whether neighborhood greenspaces were associated with physical activity in adulthood over 3 cohort visits after considering perceived safety and neighborhood contextual factors. We also evaluated whether the association with greenspace varied by neighborhood socioeconomic status. Participants (N = 4,800) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) residing in two Brazilian state capitals were evaluated in Visits 1 (2008-2010), 2 (2012-2014) and 3 (2017-2019). Greenspaces were categorized by quintiles of positive Normalized Difference Vegetation Index (NDVI) scores. Physical activity frequency was given by the number of visits at which participants reported moderate/vigorous physical activity (none, 1 or 2, and 3 visits). We used multinomial logistic regression. After adjustment for age, sex, education, research center, residence in slums, individuals in the 4th and 5th NDVI quintiles showed 73% higher odds of physical activity over 3 visits than those in the 1st quintile (4th quintile: 95%CI = 1.24-2.43; 5th quintile: 95%CI = 1.24-2.41). The strength of the association was attenuated after adjustment for perceived safety. After adjustment for contextual factors quantity of sidewalks and streetlights, the OR for the 4th and 5th NDVI quintiles decreased to 1.66 (95%CI = 1.18-2.33) and 1.62 (95%CI = 1.16-2.28), respectively. Finally, after including average household income per capita, the OR for physical activity in 3 visits for the 4th and 5th NDVI quintiles decreased to 1.48 (95%CI = 1.04-2.12) and 1.43 (95%CI = 1.00-2.04; p = 0.053), respectively. Greater greenspace contributed to sustained physical activity during the eight years of follow-up, indicating the potential contribution of public greenspaces to reducing health-related inequalities.

We aimed to compare nonalcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD) definitions concerning diabetes prediction in a large sample of Brazilian adults. As a secondary objective, we compared associations between NAFLD/MASLD and diabetes across self-declared race/skin color groups. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a prospective cohort study of Brazilian civil servants (35-74 years) enrolled from 2008 to 2010 and followed up from 2012-2014 and 2017-2019. We ascertained type 2 diabetes mellitus at baseline as well as follow-up visits based on self-reported diagnosis, medication use, and glycemic tests (fasting and 2h post-OGTT glucose and HbA1c). We excluded individuals with heavy alcohol consumption or self-reported cirrhosis/hepatitis. We analyzed 7,073 subjects. NAFLD was defined by ultrasound-based steatosis. Participants with steatosis and at least one cardiometabolic factor were considered as having MASLD. Cox proportional hazards models were performed to evaluate the association between NAFLD/MASLD and the incidence of type 2 diabetes mellitus. At baseline, 33.9% of individuals presented NAFLD and 32.5% presented MASLD. Over 9.4 years of follow-up, the relative increase in the incidence of diabetes was 78% for NAFLD (HR = 1.78; 95%CI: 1.58-2.01) and 88% for MASLD (HR = 1.88; 95%CI: 1.67-2.12). Associations did not differ significantly among race/skin color groups (p for interaction = 0.10 for MASLD and 0.08 for NAFLD). In this large cohort of middle-aged and older Brazilian adults, the relative incidence of diabetes was similar for NAFLD and MASLD definitions, with similar associations in all ethnic groups.

Thyroid-stimulating hormone (TSH) trajectory classification represents a novel approach to defining the adequacy of levothyroxine (LT4) treatment for hypothyroidism over time.

This is a proof of principle study that uses longitudinal clinical data, including thyroid hormone levels from a large prospective study to define classes of TSH trajectories and examine changes in cardiovascular (CV) health markers over the study period.

Growth mixture modeling (GMM), including latent class growth analysis (LCGA), was used to classify LT4-treated individuals participating in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) based on serial TSH levels. Repeated measure analyses were then utilized to assess within-class changes in blood pressure, lipid levels, hemoglobin A1c, and CV-related medication utilization.

From the 621 LT4-treated study participants, the best-fit GMM approach identified 4 TSH trajectory classes, as defined by their relationship to the normal TSH range: (1) high-high normal TSH, (2) normal TSH, (3) normal to low TSH, and (4) low to normal TSH. Notably, the average baseline LT4 dose was lowest in the high-high normal TSH group (77.7 µg, P < .001). There were no significant differences in CV health markers between the classes at baseline. At least 1 significant difference in CV markers occurred in all classes, highlighted by the low to normal class, in which total and high-density lipoprotein cholesterol, triglycerides, and A1c all increased significantly (P = .049, P < .001, P < .001, and P = .001, respectively). Utilization of antihypertensive, antihyperlipidemic, and antidiabetes medications increased in all classes.

GMM/LCGA represents a viable approach to define and examine LT4 treatment by TSH trajectory. More comprehensive datasets should allow for more complex trajectory modeling and analysis of clinical outcome differences between trajectory classes.

We investigated the association between job stress, as assessed by the effort-reward imbalance model, and the incidence of chronic low back pain (CLBP) over a 4-year period. A total of 1733 participants from the ELSA-Brasil Musculoskeletal cohort, who were free from LBP at baseline (2012-2014), were included. Episodes of LBP in the past 30 days, intensity, and the presence of disability were investigated in annual telephone follow-ups (2015-2018). Chronic LBP was defined as episodes of LBP lasting >3 months with at least moderate intensity. We analyzed the incidence of at least one episode of CLBP (yes/no), the number of CLBP episodes (0, 1, ≥2), and CLBP severity/disability (absent, nondisabling, severe/disabling). The association between these outcomes and tertiles of the effort-to-reward ratio, as well as each dimension of the effort-reward imbalance model, was investigated using multinomial logistic and Poisson regression models adjusting for sociodemographic and occupational variables. The cumulative incidence of CLBP over 4 years was 24.8%. High effort-reward imbalance increased the chances of experiencing multiple CLBP episodes and severe/disabling CLBP by 67% (95% confidence interval [CI]: 1.12-2.47) and 70% (95% CI: 1.14-2.53), respectively. High overcommitment increased the incidence of CLBP by 23% (95% CI: 1.01-1.50) and the chances of multiple CLBP episodes and severe/disabling CLBP by 67% (95% CI: 1.11-2.50) and 57% (95% CI: 1.05-2.34), respectively. These results indicate that exposure to job stress is associated with a higher incidence, a greater number of episodes, and increased severity of CLBP over a 4-year period. If this association is causal, measures aimed at reducing exposure to job stress are likely to alleviate the burden of CLBP.

Increased arterial stiffness is independently associated with cardiovascular risk. Obstructive sleep apnea (OSA) and sleep duration (SDUR) may contribute to increased arterial stiffness, but it is unclear whether this association is modulated by gender. We aimed to evaluate the potential impact of gender in modulating the association of OSA and SDUR with arterial stiffness. Participants from the ELSA-Brasil study performed sleep assessments with portable polygraph to define OSA severity and SDUR by 1-week wrist actigraphy. Pulse wave velocity (PWV) was measured using a standard technique without access to the sleep data. We studied 1863 participants (42.2% male, age: 49±8 years, respiratory disturbance index (RDI): 9.9 (4.5-19.4) events/h, SDUR: 6.5 (5.9-7.1) hours, mean PWV: 7.3 ± 1.2 m/s). We found that men had higher PWV, higher frequency of diabetes, and higher blood pressure when compared to women. The regression analysis showed an independent association between increased RDI and PWV in men (ß: 0.007; 95% CI: 0.001-0.012), but not in women. In contrast, an independent association between SDUR and increased arterial stiffness was observed only in women (ß: 0.068; 95% CI: 0.002-0.134). In conclusion, the association of sleep disorders with arterial stiffness showed a distinct gender pattern depending on the sleep variable studied.

Ultraprocessed foods (UPF) consumption has been associated with depression risk, but its association with depression persistence is unclear.

The objective of this study was to evaluate the association of UPF consumption with depression persistence and incidence.

The Brazilian Longitudinal Study of Adult Health is a multicenter prospective cohort study with 3 waves (2008-2010, 2012-2014, and 2017-2019). Baseline percentage of energy from UPF, measured using a food frequency questionnaire, was divided into quartiles.

Civil servants aged 35 to 74 years at baseline were included in the Brazilian Longitudinal Study of Adult Health. Participants with Parkinson disease, dementia, stroke history, extreme energy intake, and missing dietary or depression data at baseline were excluded.

Depression was based on the Clinical Interview Schedule-Revised, depression persistence on depression status at each wave and depression incidence on time to first depression diagnosis.

Clustering large applications algorithm, multinomial logistic regression, Cox proportional-hazard models, and partition substitution model were performed.

Among 13 870 participants free from depression at baseline, 731 (5.3%) had depression after 8 years of follow-up. Participants in Cluster 1 did not have depression in any wave, in Cluster 2 had depression in 1 wave, and in Cluster 3 had persistent depression in 2 or more waves. Compared with the first quartile of UPF consumption, participants in Quartiles 2, 3, and 4 had a 1.30 (95% CI 1.29 to 1.31), 1.39 (95% CI 1.38 to 1.40), and 1.58 (95% CI 1.56 to 1.60) higher odds of persistent depression (P = .019), respectively. Compared with the first UPF quartile, participants in Quartiles 3 and 4 had a 1.32 (95% CI 1.07 to 1.64) and 1.30 (95% CI 1.04 to 1.61) higher risk of incident depression (P = .017), respectively. Substituting 5%, 10%, and 20% of UPF with unprocessed/minimally processed foods and culinary ingredients was associated with a 6%, 11%, and 22% decreased depression incidence, respectively.

Higher consumption of UPF at baseline was associated with higher odds of persistent depression and higher risk of incident depression over 8 years of follow-up.

Gender differences may interfere with the association between Negative Life Events (NLEs) and prevalent/incident depression. This study evaluated the effect of gender in this association using data from the ELSA-Brazil cohort.

The authors analyzed 15,088 participants (mean age, 52.1 (9.1), 54.4 % women). NLEs (robbery, hospitalization, death of a close relative, financial hardship, and rupture of a love relationship) were accessed at baseline. Depression was assessed at baseline and follow-ups. The authors built logistic (Odds Ratio [OR], 95 % Confidence Interval [95 % CI]) and Poisson regression models (Relative Risk [RR], [95 % CI]) to evaluate this association.

Women reported more NLEs compared to men. The authors found associations between NLEs and prevalent depression: for men, hospitalization (OR = 1.83; 95 % CI 1.16‒2.91), financial hardship (OR = 2.42; 95 % CI 1.69‒3.49), rupture of a love relationship (OR = 2.54; 95 % CI 1.50‒4.29), and any NLE (OR = 2.30; 95 % CI 1.59‒3.35); and for women, robbery (OR = 1.81; 95 % CI 1.31‒2.49), hospitalization (OR = 1.46; 95 % CI 1.11‒1.92), financial hardship (OR = 1.76; 95 % CI 1.43‒2.17), rupture of a love relationship (OR = 1.66; 95 % CI 1.20‒2.32), and any NLE (OR = 1.65; 95 % CI 1.34‒2.04). For incident depression only financial hardship (RR = 2.09; 95 % CI 1.55‒2.83) was associated with depression in men, while, for women, robbery (RR = 1.54; 95 % CI 1.16‒2.04); hospitalization (RR = 1.36; 95 % CI 1.07‒1.74), financial hardship (RR = 1.37; 95 % CI 1.14‒1.65), and any NLE (RR = 1.25; 95 % CI 1.04‒1.49) were associated with incident depression. No association was found between the death of a close relative and prevalent/incident depression.

NLEs were associated with depression in men and women, with a higher impact in the latter.

AI-enhanced 12-lead ECG can detect a range of structural heart diseases (SHDs) but has a limited role in community-based screening. We developed and externally validated a noise-resilient single-lead AI-ECG algorithm that can detect SHD and predict the risk of their development using wearable/portable devices.

Using 266,740 ECGs from 99,205 patients with paired echocardiographic data at Yale New Haven Hospital, we developed ADAPT-HEART, a noise-resilient, deep-learning algorithm, to detect SHD using lead I ECG. SHD was defined as a composite of LVEF<40%, moderate or severe left-sided valvular disease, and severe LVH. ADAPT-HEART was validated in four community hospitals in the US, and the population-based cohort of ELSA-Brasil. We assessed the model's performance as a predictive biomarker among those without baseline SHD across hospital-based sites and the UK Biobank.

The development population had a median age of 66 [IQR, 54-77] years and included 49,947 (50.3%) women, with 18,896 (19.0%) having any SHD. ADAPT-HEART had an AUROC of 0.879 (95% CI, 0.870-0.888) with good calibration for detecting SHD in the test set, and consistent performance in hospital-based external sites (AUROC: 0.852-0.891) and ELSA-Brasil (AUROC: 0.859). Among those without baseline SHD, high vs. low ADAPT-HEART probability conferred a 2.8- to 5.7-fold increase in the risk of future SHD across data sources (all P<0.05).

We propose a novel model that detects and predicts a range of SHDs from noisy single-lead ECGs obtainable on portable/wearable devices, providing a scalable strategy for community-based screening and risk stratification for SHD.

We aimed at defining the direct and the mediated pathways for the association between leisure-time physical activity (LTPA) and carotid-to-femoral pulse wave velocity (cf-PWV), and also to identify whether these effects are influenced by sex and age.

Cross-sectional data from 13 718 adults (35-74 years) were obtained at the baseline of the ELSA-Brasil study. The cf-PWV was obtained by measuring the pulse transit time and the distance traveled by the pulse between the carotid and the femoral, as well as clinical and anthropometric parameters were measured. The levels of LTPA were determined by applying the long form of the International Physical Activity Questionnaire (IPAQ).

Classical cardiovascular risk factors were independently associated with cf-PWV. Path analysis showed that increased levels of LTPA were directly associated with lower cf-PWV in both men and women ( β : -0.123 ± 0.03 vs. 0.065 ± 0.029, P for sex = 0.165), except for diabetes. Also, the mediated effect of LTPA on SBP and DBPs, heart rate, BMI, and fasting glucose, was associated with lower cf-PWV in men and women ( β : -0.113 ± 0.016 vs. -0.104 ± 0.016, P for sex = 0.692), except for diabetes. When age was tested as a moderator, the direct effect did not change significantly according to participants' age, regardless of sex. However, the mediated effect increases in both men and women over 50 years.

Our findings support that LTPA in adults reduces cf-PWV by acting in different ways according to age. Physical activity in older individuals improves cardiometabolic risk factors and thus mitigates the stiffening of large arteries.

Insulin resistance (IR) is a risk factor for several cardiometabolic disorders; however, there is conflicting evidence about the reliability of certain IR markers. In this context, the triglyceride-glucose index (TyG) has been proposed as a surrogate marker for IR. This study aimed to compare the TyG index and homeostasis model assessment of insulin resistance (HOMA-IR).

A cross-sectional analysis was conducted using baseline data from 11,314 adults (aged 35-74 years) from the ELSA-Brasil study. The correlation between TyG and HOMA-IR, their interrater reliability, and their predictive value in identifying metabolic syndrome (MetS) were assessed. The mean TyG and HOMA-IR in our sample were 8.81 ± 0.52 and 2.78 ± 1.58 for men, and 8.53 ± 0.48 and 2.49 ± 1.38 for women, respectively. TyG and HOMA-IR showed a weak to moderate correlation with each other (Pearson's r for men: 0.395 and 0.409 for women, p-value <0.05) and other markers of glycemic metabolism. Additionally, the area under the curve for the prediction of MetS was greater for TyG than HOMA-IR, regardless of sex (TyG: 0.836 for men and 0.826 for women; HOMA-IR: 0.775 for men and 0.787 for women). The concordance between these markers was low (Coheńs kappa coefficient: 0.307 for men and 0.306 for women). Individuals with increased TyG exhibited mainly anthropometrical and glycemic metabolic alterations, whereas those with elevated HOMA-IR displayed mostly lipid-associated metabolic alterations.

TyG and HOMA-IR might indicate different profiles of cardiometabolic disorders, showing poor agreement in classifying individuals (normal vs. altered) and a weak correlation. Therefore, further studies are needed to investigate the role of TyG as a surrogate marker of IR.

The EAT-Lancet Commission proposed a planetary health diet to improve human health within planetary boundaries; however, little is known about the association between adherence to this diet and cognitive decline. We used data from three waves of the Brazilian Longitudinal Study of Adult Health to evaluate the association between the planetary health diet and cognitive decline using linear mixed-effects models. Here we show that in 11,737 participants (mean (s.d.) age 51.6 (9.0) years, 54% women and 53% white), higher adherence to the planetary health diet was associated with slower memory decline (P = 0.046) and that income was a modifier in this association (P < 0.001). Adherence to the planetary health diet was associated with slower decline of memory (P = 0.040) and global cognition (P = 0.009) in high-income participants. No association was found among low-income participants. The results of our study highlight that the promotion of healthy dietary patterns should take into consideration income barriers as well as differences in dietary habits to achieve high adherence.

Atrial fibrillation (AF) and stroke are prevalent conditions worldwide, and the AF burden is expected to concentrate in low- and middle-income countries like Brazil. The National Institute for Health and Care Excellence-funded Global Health Research Group on Atrial Fibrillation Management (GHRG-AF) had a Brazilian arm that addressed AF epidemiology and care in Brazil. GHRG-AF analyzed data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a long-term cohort of 15,105 middle-aged adults in Brazil, focused on cardiovascular disease and diabetes. Additionally, the GHRG-AF used data from the Brazilian Study of Stroke Mortality and Morbidity (EMMA) study to understand AF impact on this cohort of 1863 stroke survivors, all admitted to a community hospital. The GHRG-AF also surveyed healthcare practices and the pathways of individuals who live with AF, interviewing health professionals and patients treated in different healthcare units in São Paulo. Despite these multiple approaches, those data were restricted to individuals living in large urban centers. Approximately 70% of the Brazilian territory comprises sparsely populated cities (<10 inhabitants/km2), which, as a group, are home to 15 million individuals. In a new step, the GHRG-AF collaborators aim to improve cardiovascular research capacity in distant locations of the Brazilian Amazon, develop patient-centered protocols, empower community health agents in the region, and intensify collaboration with other research groups in remote parts of the country.