Relationship between cardiometabolic alterations and frailty in Brazilian urban and rural older adults

BACKGROUND: Frailty is a major public health concern among older adults due to its association with disability, hospitalization, and mortality. Cardiometabolic alterations are prevalent in this population and may be associated with frailty. However, evidence remains limited, particularly across different residential contexts. OBJECTIVE: Investigate the association between cardiometabolic alterations and pre-frailty and frailty among Brazilian older adults. METHODS: This cross-sectional study used data from the baseline survey (2015-2016) of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a nationally representative, population-based cohort study. The sample was selected using a multistage, stratified cluster sampling design. A total of 4,368 individuals aged 60 years were included. Frailty was assessed according to the Fried phenotype. Cardiometabolic alterations included diabetes mellitus, hypertension, high cholesterol, excess body weight, abdominal obesity, and cardiovascular risk. Multinomial logistic regression models were used to estimate crude and adjusted odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS: The prevalence of pre-frailty and frailty was 58.3% and 12.3%, respectively. Diabetes mellitus, hypertension, excess body weight, abdominal obesity, and the presence of three or more cardiometabolic alterations were independently associated with higher odds of pre-frailty and frailty after adjustment. A dose-response relationship was observed between the number of cardiometabolic alterations and frailty status. CONCLUSION: Cardiometabolic alterations are associated with pre-frailty and frailty among Brazilian older adults. The dose-response relationship between the number of alterations and frailty status highlights the relevance of accumulated cardiometabolic burden as a marker of vulnerability to frailty and supports integrated strategies for cardiometabolic risk prevention and management. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40200-026-02046-8.