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OBJECTIVE: To determine the effectiveness of the McKenzie Method compared to any conservative interventions on pain and disability in patients with chronic low back pain (LBP) with directional preference (DP). METHODS: We searched six electronic databases up to September 2022. Eligible randomized controlled trials were those assessing the McKenzie Method delivered by credentialed therapists for chronic LBP with DP. Two reviewers independently selected studies, extracted data, assessed risk of bias with the revised Cochrane Risk of Bias 2.0 tool and certainty of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RESULTS: Five trials (n = 743) were included. There was low-certainty evidence that the McKenzie Method, compared to all other interventions combined, produced clinically important reductions in short-term pain (mean difference [MD] -1.11 points on a 10-point scale; 95% CI -1.83 to -0.40) and in intermediate-term disability (standardized mean difference [SMD] -0.53; 95% CI -0.97 to -0.09). Low-to-moderate certainty evidence showed that the McKenzie Method also resulted in clinically important improvements in short-term pain (MD -1.53; 95% CI -2.51 to -0.54) and disability (SMD -0.50; 95% CI -0.74 to -0.25) when compared specifically to other exercise approaches, and in intermediate-term pain (MD -2.10; 95% CI -2.94 to -1.26) and disability (SMD -1.01; 95% CI -1.58 to -0.43) as well as long-term disability (SMD -0,59; 95% CI -1.14 to -0.03) when compared to minimal intervention. Low-certainty evidence showed usually small, clinically unimportant effects in comparison to manual therapy. CONCLUSION: We found low-to-moderate certainty evidence that the McKenzie Method was superior to all other interventions combined for up to 6 months for pain and up to 12 months for disability, with clinically important differences versus exercise in the short term and versus minimal interventions in the intermediate term. The only clinically important long-term effect was on disability compared to minimal intervention.

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Background/Objective: Diabetes registries that enhance surveillance and improve medical care are uncommon in low- and middle-income countries, where most of the diabetes burden lies. We aimed to describe the methodological and technical aspects adopted in the development of a municipal registry of people with diabetes using local and national Brazilian National Health System databases. Methods: We obtained data between July 2018 and June 2021 based on eight databases covering primary care, specialty and emergency consultations, medication dispensing, outpatient exam management, hospitalizations, and deaths. We identified diabetes using the International Classification of Disease (ICD), International Classification of Primary Care (ICPC), medications for diabetes, hospital codes for the treatment of diabetes complications, and exams for diabetes management. Results: After data processing and database merging using deterministic and probabilistic linkage, we identified 73,185 people with diabetes. Considering that 1.33 million people live in Porto Alegre, the registry captured 5.5% of the population. Conclusions: With additional data processing, the registry can reveal information on the treatment and outcomes of people with diabetes who are receiving publicly financed care in Porto Alegre. It will provide metrics for epidemiologic surveillance, such as the incidence, prevalence, rates, and trends of complications and causes of mortality; identify inadequacies; and provide information. It will enable healthcare providers to monitor the quality of care, identify inadequacies, and provide feedback as needed.

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Background and Objective: Hypertension and type-2 diabetes are strong risk factors for cardiovascular diseases, and their management requires lifestyle changes, including a shift in dietary habits. The consumption of salt has increased in the last decades in some countries, but its association with type-2 diabetes remains unknown. Thus, we aimed to estimate the amount of salt intake among adults with and without diabetes and to assess whether concomitant hypertension and diabetes are associated with higher salt intake. Methods: Data from 11,982 adults 35-74 years of age enrolled in the baseline of the Longitudinal Study of Adult Health-Brasil study (2008-2010) were studied. A clinical and anthropometric evaluation was performed, and their daily salt intake was estimated by the overnight 12-hr urine sodium excretion. Results: Salt intake (gram per day) was higher in participants with diabetes as compared with those without diabetes, regardless of sex (men: 14.2 ± 6.4 vs. 12.4 ± 5.6, P < 0.05; women: 10.5 ± 4.8 vs. 9.1 ± 4.1, P < 0.05). However, salt intake is high in participants with fasting glucose ≥126 mg/dL or HbA1c ≥6.5%, but not in participants with blood glucose 2 hr after the glucose tolerance test ≥200 mg/dL. When hypertension and diabetes coexisted, salt consumption was higher than among people without these conditions. The prevalence of hypertension increased with increasing salt intake in women with diabetes, but not in men with this condition. Conclusions: Our findings highlight the high consumption of salt in individuals with diabetes and/or hypertension, and the need for effective strategies to reduce salt consumption in these groups of increased risk for major cardiovascular events, especially in women.

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OBJECTIVE: To assess leisure-time physical activity (LTPA) as a modifier of the diabetes/cognitive decline association in middle-aged and older participants in the Estudo Longitudinal de Saude do Adulto (ELSA-Brasil) study. RESEARCH DESIGN AND METHODS: ELSA-Brasil is a cohort of 15,105 participants (age 35-74 years) enrolled between 2008 and 2010. We evaluated global cognitive function, summing the scores of six standardized tests evaluating memory and verbal fluency, including the Trail-Making Test, at baseline and follow-up. Incident cognitive impairment was defined as a global cognitive function score at follow-up lower than -1 SD from baseline mean. Participants reporting ≥150 min/week of moderate to vigorous LTPA at baseline were classified as physically active. We assessed the association of LTPA with global cognition change in those with diabetes in the context of our overall sample through multivariable regression models. RESULTS: Participants' (N = 12,214) mean age at baseline was 51.4 (SD 8.8) years, and 55.5% were women. During a mean follow-up of 8.1 (SD 0.6) years, 9,345 (76.5%) inactive participants and 1,731 (14.1%) participants with diabetes at baseline experienced faster declines in global cognition than those who were active (ß = -0.003, -0.004, and -0.002) and those without diabetes (ß = -0.004, -0.005, and -0.003), respectively. Diabetes increased the risk of cognitive impairment (hazard ratio [HR] 1.71; 95% Cl 1.22, 2.39) in inactive but not in active adults (HR 1.18; 95% CI 0.73, 1.90). Among participants with diabetes, those who were active showed a delay of 2.73 (95% CI 0.94, 4.51) years in the onset of cognitive impairment. CONCLUSIONS: In adults living with diabetes, LTPA attenuated the deleterious association between diabetes and cognitive function.

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The mechanisms underlying racial inequities in uncontrolled hypertension have been limited to individual factors. We investigated racial inequities in uncontrolled hypertension and the explanatory role of economic segregation in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). All 3897 baseline participants with hypertension (2008-2010) were included. Uncontrolled hypertension (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg), self-reported race (White/Brown/Black people), and neighborhood economic segregation (low/medium/high) were analyzed cross-sectionally. We used decomposition analysis, which describes how much a disparity would change (disparity reduction; explained portion) and remain (disparity residual; unexplained portion) upon removing racial differences in economic segregation (i.e., if Black people had the distribution of segregation of White people, how much we would expect uncontrolled hypertension to decrease among Black people). Age- and gender-adjusted prevalence of uncontrolled hypertension (39.0%, 52.6%, and 54.2% for White, Brown, and Black participants, respectively) remained higher for Black and Brown vs White participants, regardless of economic segregation. Uncontrolled hypertension showed a dose-response pattern with increasing segregation levels for White but not for Black and Brown participants. After adjusting for age, gender, education, and study center, unexplained portion (disparity residual) of race on uncontrolled hypertension was 18.2% (95% CI 13.4%; 22.9%) for Black vs White participants and 12.6% (8.2%; 17.1%) for Brown vs White participants. However, explained portion (disparity reduction) through economic segregation was - 2.1% (- 5.1%; 1.3%) for Black vs White and 0.5% (- 1.7%; 2.8%) for Brown vs White participants. Although uncontrolled hypertension was greater for Black and Brown vs White people, racial inequities in uncontrolled hypertension were not explained by economic segregation.

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BACKGROUND: Life's Simple 7, a lifestyle and cardiovascular index associated with cognition, has been updated to Life's Essential 8 (LE8) to include sleep. LE8 has been related to cardiovascular outcomes but its association with cognition is unclear. METHODS: In this longitudinal analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), LE8 score was based on health behaviors (diet, physical activity, nicotine exposure, and sleep health) as well as health-related factors (body mass index, blood lipids, blood glucose, and blood pressure). Cognition was assessed in three waves, 4 years apart, using the Consortium to Establish a Registry for Alzheimer's Disease - Word List, semantic and phonemic verbal fluency, the Trail-Making Test B (TMT-B), and a global composite score. We used linear mixed-model analysis, inverse probability weighting, and interaction analysis. RESULTS: At baseline, the mean age of the study cohort was 51.4 ± 8.9 years, 56% were women, and 53% were White. Higher baseline LE8 scores were associated with slower decline in global cognition (ß = 0.001, 95% confidence interval [CI] 0.001, 0.002; p < 0.001), memory (ß = 0.001, 95% CI 0.000, 0.002; p = 0.013), verbal fluency (ß = 0.001, 95% CI 0.000, 0.002; p = 0.003), and TMT-B (ß = 0.004, 95% CI 0.003, 0.005; p < 0.001). This association was mainly driven by LE8 health factors, particularly blood glucose and blood pressure. Age, sex, and race were modifiers of the association between LE8 and global cognitive decline (p < 0.001), suggesting it was more pronounced in older, male, and Black participants. CONCLUSIONS: Higher baseline LE8 scores were associated with slower global and domain-specific cognitive decline during 8 years of follow-up, mainly due to health factors such as blood glucose and blood pressure. Sociodemographic factors were modifiers of this association.

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BACKGROUND: To prevent diabetes complications, the American Diabetes Association (ADA) has recommended the treatment of blood glucose, blood pressure, and LDL-cholesterol (LDL-c) to target levels. Our aim is to characterize the risk of death according to the achievement of these goals in subjects with diabetes participating in the ELSA-Brasil study. METHODS: ELSA-Brasil is an occupational cohort study of middle-aged and elderly adults followed from a 2008-2010 baseline to 2019 by two additional clinic visits and annual telephone interviews. We ascertained known diabetes by self-reported diagnosis or anti-diabetic medication use. We used treatment targets based on the 2022 ADA guidelines. We ascertained deaths from any cause based on the annual surveillance confirmed by death certificates. RESULTS: After 11 (1.8) years of follow-up, 261 subjects had died among 2423 with known diabetes. Within-target HbA1c was associated with the greatest protection (HR = 0.66; 95%CI 0.50-0.88) against all-cause mortality. Achieving both glycemic and blood pressure targets conferred substantial protection (HR = 0.54; 95%CI 0.37-0.78). Within-target LDL-c, however, was associated with increased mortality (HR = 1.44; 95%CI 1.11-1.88). CONCLUSIONS: Glucose and blood pressure control, especially when concomitant, reduced mortality. The increased mortality associated with achieving the LDL-c target merits further investigation.

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OBJECTIVE: Expressing the cardiovascular disease (CVD) risk in relation to peers may complement the estimation of absolute CVD risk. We aimed to determine 10-year CVD risk percentiles by sex and age in the Brazilian population and evaluate their association with estimated long-term atherosclerotic CVD (ASCVD) risk. METHODS: A cross-sectional analysis of baseline data from the ELSA-Brasil study was conducted in individuals aged 40-74 years without prior ASCVD. Ten-year CVD risk and long-term ASCVD risk were estimated by the WHO risk score and the Multinational Cardiovascular Risk Consortium tool, respectively. Ten-year risk percentiles were determined by ranking the calculated risks within each sex and age group. RESULTS: Ten-year CVD risk versus percentile plots were constructed for each sex and age group using data from 13,364 participants (55% females; median age, 52 [IQR, 46-59] years). Long-term ASCVD risk was calculated in 12,973 (97.1%) participants. Compared to individuals at the <25th risk percentile, those at the ≥75th percentile had a greater risk of being in the highest quartile of long-term risk (ORs [95% CIs] 6.57 [5.18-8.30] in females and 11.59 [8.42-15.96] in males) in regression models adjusted for age, race, education, and 10-year CVD risk. In both sexes, the association between risk percentile and long-term risk weakened after age 50. A tool for calculating 10-year CVD risk and the corresponding percentile is available at https://bit.ly/3CzPUi6. CONCLUSIONS: We established percentiles of predicted 10-year CVD risk by sex and age in the Brazilian population, which independently reflect the estimated long-term ASCVD risk in younger individuals.

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BACKGROUND: Ultra-processed food (UPF) consumption increases the risk of type 2 diabetes in various high-income countries, with some variation in the magnitude across studies. Our objective was to investigate the association of UPF consumption and specific subgroups with incident type 2 diabetes in Brazilian adults. METHODS: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a multicenter cohort study of 15,105 adults (35-74 years) enrolled in public institutions in Brazil (2008-2010). We followed participants with two clinic visits (2012-2014; 2017-2019) and annual telephone surveillance. After excluding those with diabetes at baseline, who died or were lost in the follow-up, with missing data, with implausible energy food intake, or reporting bariatric surgery, there were 10,202 participants. We used the NOVA classification to assess UPF consumption based on a food frequency questionnaire. We defined type 2 diabetes by self-report, medication use, or comprehensive laboratory tests. We estimated relative risks (RR) and 95% confidence intervals (95% CI) using robust Poisson regression. RESULTS: Median UPF consumption was 372 g/day. Over 8.2 (0.7) years of follow-up, we detected 1799 (17.6%) incident cases. After adjustment for socio-demographics, family history of diabetes, and behavioral risk factors, comparing the fourth (≥ 566 g/day) with the first (< 236 g/day) quartile of UPF distribution, RR was 1.24 (1.10-1.39); every 150 g/day increments in UPF consumption resulted in a RR of 1.05 (1.03-1.07). Reclassifying natural beverages with added sweeteners as UPF increased risk (RR 1.40; 1.25-1.58). Among UPF subgroupings, consumption of processed meats and sweetened beverages increased diabetes risk, while yogurt and dairy sweets decreased the risk (p < 0.05). CONCLUSIONS: UPF consumption increased the incidence of type 2 diabetes in Brazilian adults, with heterogeneity across specific food items. These findings add to previous evidence for the role of UPFs in the development of diabetes and other chronic diseases, supporting recommendations to avoid their intake in diabetes prevention and management.

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Atherosclerosis burden can be evaluated in asymptomatic patients by measuring coronary artery calcification (CAC), whereas the global longitudinal strain (GLS) and diastolic function parameters (mitral E/e' ratio, septal e', and lateral e') are used to evaluate subclinical left ventricular (LV) dysfunction. We investigated whether subjects with CAC (CAC >0 Agatston units) would present with an impairment in LV functional parameters. Among the participants of the ELSA-Brasil cohort free of clinically prevalent cardiovascular disease who performed cardiac computed tomography and echocardiography within the study protocol, we tested whether those with CAC >0 presented with worse GLS and diastolic function parameters. CAC >0 was present in 203 of the 612 included participants (33.17%; age 51.4 ± 8.6 years, 52.1% women). Absolute CAC values did not correlate with GLS (ro = 0.07, p = 0.105) but did so with E/e' (ro = 0.19, p <0.001), septal e' (ro = 0.28, p <0.001), and lateral e' (ro = 0.30, p <0.001), with stronger correlations in men. Those with CAC >0 had worse mitral E/e' ratios (7.75 ± 0.13 vs 7.01 ± 0.09; p ≤0.001), septal e' (8.25 ± 0.15 vs 9.59 ± 0.11 cm/s; p <0.001), and lateral e' (10.13 ± 0.20 vs 11.99 ± 0.14 cm/s; p ≤0.001), respectively. However, these associations were not independent of diabetes, obesity, hypertension, smoking, and low-density lipoprotein cholesterol, persisting only as significant associations of CAC >0 with mitral E/e' ratio and septal e' in men. There is an association between subclinical coronary atherosclerosis and impaired LV functional parameters. These associations are more likely attributed to the presence of common cardiovascular risk factors in the general population. However, in men, it seems to exist as an independent association.

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OBJECTIVES: The association between metabolic syndrome (MetS), a cluster of cardiometabolic risk factors, and salt consumption has fed intense debate in recent years, although it is yet to be fully elucidated. We aimed to evaluate whether individuals with MetS have a high salt consumption and to identify which components of the MetS diagnosis could be independently related to high salt consumption. METHODS: We analyzed data from 11 982 adults, ages 35 to 74 y, from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort study, from which clinical and anthropometric data were assessed, and a validated 12-h overnight urine collection was used to estimate salt intake. MetS was defined according to the Adult Treatment Panel III criteria. RESULTS: Salt intake was increased in individuals with MetS compared with individuals without MetS, regardless of sex (men: 14.3 ± 6.4 g/d versus 12.2 ± 5.5 g/d, P < 0.001; women: 10.6 ± 4.9 g/d versus 8.9 ± 4.0 g/d, P < 0.001) and increased progressively as the MetS criteria accumulated. The high salt intake in MetS participants, however, was observed only in the presence of elevated waist circumference and/or blood pressure and not with the other MetS criteria (reduced high-density lipoprotein, increased triglycerides, and impaired fasting blood glucose), regardless of the presence of MetS. When diabetes was incorporated as a MetS criterion, increased salt intake was observed in men but not in women. CONCLUSIONS: Salt intake should be reduced worldwide, but strategies must be more intense in people with elevated blood pressure and waist circumference, regardless of MetS diagnosis, to avoid the associated morbidity and mortality.

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Right ventricular (RV) free wall longitudinal strain (RVFWLS), and four-chamber longitudinal strain (RV4CLS) using speckle tracking echocardiography have demonstrated increased accuracy and discrimination to measure right ventricular function in different clinical conditions. Reproducibility data of these measures are scarce and mainly tested in small or reference populations. The main objective of this study was to investigate their reproducibility, and of other traditional RV parameters, from unselected participants of a large cohort study. RV strain reproducibility was analyzed using echocardiographic images of 50 participants from a randomly selected sample from The ELSA-Brasil Cohort. Images were acquired and analyzed following the study protocols. The mean RVFWLS was - 26.9 ± 2.6% and the mean RV4CLS was - 24.4 ± 1.9%. The intra-observer reproducibility parameters of RVFWLS demonstrated a coefficient of variation (CV) of 5.1% and an intraclass correlation coefficient (ICC [95%CI] 0.78[0.67-0.89]), and for RV4CLS were CV = 5.1% and ICC = 0.78[0.67-0.89]. Reproducibility for RV fractional area change was CV = 12.1%; ICC = 0.66 [0.50-0.81] and for RV basal diameter was CV = 6.3%; ICC = 0.82 [0.73-0.91]. The inter-observer reproducibility for RVFWLS was CV = 8.3%; ICC 0.54[0.34-0.74] and for RV4CLS, CV = 6.3%; ICC = 0.53[0.34-0.73], following the same pattern among conventional RV parameters. We found adequate reproducibility of RV longitudinal strain parameters. This information is relevant for the long-term follow-up of cohort participants and reinforces the utility of RV longitudinal strain as a tool to monitor subclinical changes in RV systolic function.

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Background: Screening for undiagnosed diabetes using glucose testing is recommended globally to allow preventive action among those detected. Our aim was to evaluate the access to glucose testing to screen for diabetes in Brazil using self-reported information on recent testing and medical consultation from national surveys of Brazilian adults. Methods: The Pesquisa Nacional de Saúde (PNS) was conducted in 2013 and 2019 drawing probabilistic samples of Brazilians aged 18 years and above. To evaluate glucose testing among those undiagnosed, we excluded those self-reporting a previous diagnosis of diabetes. We then defined recent access to diabetes diagnosis by considering the previous two years and choosing the last blood glucose test and the proximal medical consultation reported. We used Poisson regression with robust variance to assess correlates of access, expressing them with adjusted prevalence ratios (PR) and their 95% confidence intervals. Results: Access to recent glucose testing documented that over 70% reported a recent glycemic test, 71% in 2013, and 77% in 2019. These findings are consistent with a wide recent access to medical consultation, 86% and 89% in 2013 and 2019, respectively. Reporting recent glucose testing and medical consultation may better reflect the actual access to medical diagnostic testing. When analyzing this joint outcome, diagnostic access was still wide, 67% and 74%, respectively. Greater access (p< 0.001) was seen for women (PR=1.16; 1.15-1.17), older individuals (PR=1.25; 1.22-1.28), and those with higher education (PR=1.17; 1.15-1.18), obesity (PR=1.06; 1.05-1.08), and hypertension (PR=1.12; 1.11-1.13). In contrast, lower access (p<0.001) was seen for those declaring being Black (PR=0.97; 0.95-0.99) or of mixed-race (PR=0.97; 0.96-0.98), those residing in rural areas (PR=0.89; 0.87-0.90), and not having a private health insurance plan (PR=0.85; 0.84-0.86). Conclusions: Although access to diagnostic testing for diabetes is high in Brazil, partly due to its universal health system, social inequities are still present, demanding specific actions, particularly in rural areas and among those self-declaring as being Black or mixed-race.

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The association of diabetes with increased large artery stiffness is not definitively established. We aimed to describe the carotid-femoral pulse wave velocity (cf-PWV) in participants with and without diabetes and whether the cf-PWV could vary among the different laboratory-based criteria used. A cross-sectional analysis using baseline data from 13,912 adults was used. cf-PWV as well as anthropometric, biochemical, and clinical data were measured. Diabetes was defined by previous medical diagnosis, medication use, fasting glucose, an oral glucose tolerance test (GTT), or glycated hemoglobin (HbA1c). The prevalence of diabetes was 18.7%, higher in men than in women. After adjustment, participants with diabetes showed higher cf-PWV (men: 9.7 ± 1.7 vs 9.4 ± 1.7 m/s, P < .05; women: 9.4 ± 1.6 vs 9.1 ± 1.7 m/s, P < .05). We observed a progressive increase in cf-PWV as >1 laboratory-based criterion for diabetes diagnosis was reached. Also, participants with diabetes with alterations in any laboratory-based criteria had higher cf-PWV than participants without diabetes, regardless of sex. In summary, diabetes is associated with higher cf-PWV as is each laboratory-based parameter used for its diagnosis. These results support the strong consequences of glucose dysregulation on the vascular system and provide evidence to screen all parameters involved in glycemic metabolism to improve vascular health.

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BACKGROUND: Control of glucose, blood pressure, cholesterol, and smoking improves the prognosis of individuals with diabetes mellitus. Our objective was to assess the level of control of these risk factors in Brazilian adults with known diabetes and evaluate correlates of target achievement. METHODS: Cross-sectional sample of the Brazilian Longitudinal Study of Adult Health, composed of participants reporting a previous diagnosis of diabetes or the use oof antidiabetic medication. We measured glycated hemoglobin (HbA1c) and LDL-cholesterol at a central laboratory and blood pressure following standardized protocols. We defined HbA1c < 7% as glucose control (target A); blood pressure < 140/90 mmHg (or < 130/80 mmHg in high cardiovascular risk) as blood pressure control (target B), and LDL-c < 100 mg/dl (or < 70 mg/dl in high risk) as lipid control (target C), according to the 2022 American Diabetes Association guidelines. RESULTS: Among 2062 individuals with diabetes, 1364 (66.1%) reached target A, 1596 (77.4%) target B, and 1086 (52.7%) target C; only 590 (28.6%) achieved all three targets. When also considering a non-smoking target, those achieving all targets dropped to 555 (26.9%). Women (PR = 1.13; 95%CI 1.07-1.20), those aged ≥ 74 (PR = 1.20; 95%CI 1.08-1.34), and those with greater per capita income (e.g., greatest income PR = 1.26; 95%CI 1.10-1.45) were more likely to reach glucose control. Those black (PR = 0.91; 95%CI 0.83-1.00) or with a longer duration of diabetes (e.g., ≥ 10 years PR = 0.43; 95%CI 0.39-0.47) were less likely. Women (PR = 1.05; 95%CI 1.00-1.11) and those with private health insurance (PR = 1.15; 95%CI 1.07-1.23) were more likely to achieve two or more ABC targets; and those black (PR = 0.86; 95%CI 0.79-0.94) and with a longer duration of diabetes (e.g., > 10 years since diabetes diagnosis, PR = 0.68; 95%CI 0.63-0.73) less likely. CONCLUSION: Control of ABC targets was poor, notably for LDL-c and especially when considering combined control. Indicators of a disadvantaged social situation were associated with less frequent control.

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BACKGROUND: Diabetes is an important public health problem due to its health impairments and high costs for health services. We analyzed the relationship between the domains of physical activity at leisure-time (LTPA) and at commuting (CPA) with diabetes and pre-diabetes in an ELSA-Brasil study. METHODS: Data from 11,797 participants (52.5% women, 49.1 ± 7.2 years) were analyzed. LTPA and CPA were measured using the International Physical Activity Questionnaire. Diabetes and pre-diabetes were defined by medical history, medication use to treat diabetes or blood glucose. Logistic regression models were performed to estimate the association between LTPA and CPA with diabetes and pre-diabetes after adjustment for sociodemographic and cardiovascular risk factors. RESULTS: The prevalence of LTPA and CPA was 24.4% and 34%, respectively. Physically active participants at LTPA were less likely to have pre-diabetes (OR = 0.86 [95% CI = 0.77-0.95]) and diabetes (OR = 0.80 [95% CI = 0.69-0.93]), compared with inactive participants. No association between CPA and diabetes/pre-diabetes was observed. LTPA was inversely associated with diabetes among men (OR = 0.73 [95% CI = 0.60-0.89]), but was not associated among women. Women who were active (OR = 0.78 [95% CI = 0.67-0.90]) (OR = 0.79 [95% CI = 0.65-0.95]) at LTPA were less likely to have pre-diabetes, than inactive women. CONCLUSION: LTPA was inversely associated with diabetes and pre-diabetes in the ELSA-Brasil participants. A different behavior was observed between genders.

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Atherogenic dyslipidemia is a risk factor for cardiovascular diseases. The present study aimed to evaluate the association between triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and the triglycerides to high-density lipoprotein (TG/HDL-C) ratio with carotid-femoral pulse wave velocity (cf-PWV), a marker of vascular stiffness. Anthropometric, biochemical, and clinical data from 13,732 adults were used to assess this association. Individuals within the third TG/HDL-C tertile presented worse anthropometric, biochemical, and clinical profiles as compared with the participants in the lower TG/HDL-C tertile. There was a linear association between TG, HDL-C, and TG/HDL-C ratio and cf-PWV in both men and women (stronger in women). After adjustment for confounders, lower levels of HDL-C were associated with increased cf-PWV in men (9.63 ± .02 m/s) and women (8.90 ± .03 m/s). However, TG was not significantly associated with cf-PWV after adjustment, regardless of sex. An increased TG/HDL-C ratio is associated with higher cf-PWV only in women (9.01 ± .03 m/s), but after adjustment for HDL-C levels, the association was non-significant (8.99 ± .03 m/s). These results highlight the stronger association of HDL-C with arterial stiffness, and that the association of TG/HDL-C with cf-PWV is dependent on HDL-C.

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