Morning. I would like to welcome all of you to the earnings release call of Grupo Fleury for the first quarter, 2026. We have here with us Ms. Jeane Tsutsui, CEO of the company, José Filippo, CFO, and Renato Braun, IR Officer. Would like to let you know that this event is being recorded, and we have simultaneous translation into English. First, we're going to share the results of the company, and next, we are going to start the question and answer session. Once the session is concluded, Mr. Tsutsui is going to make some closing remarks. All the numbers that are going to be referred are compared to the same period 2025, except if specified, and they have been all rounded up to the closest million level. This information may also have information about future events.
Such forward-looking statements are not only history facts, but they also reflect the wishes and projections of the company. The words believe, hope, plan, estimate, predict, projects, and desires are statements that necessarily involve risks which are known and unknown. Known risks include uncertainties which are not related with the impact of competitiveness of prices and services. Among uncertainties, we also have acceptance of services, company and competitor service transactions, regulatory approval, currency fluctuation, changes in the mix of services offered, and other risks described in the company's reports. I would now like to hand it over to Ms. Jeane Tsutsui.
Good morning, everyone. Thank you very much for being part of the earnings release call of the first quarter, 2026 of Grupo Fleury. In our schedule today, we are going to give you an overview of our business and the main strategic pillars.
Next, we are going to talk about our 100-year anniversary with the opening of a special unit, 100-year milestone unit. We are going to make some highlights of the financial results. The result of the first quarter 2026 show the strength of our business model and our culture marked by sustainable growth, very strict discipline, and focus on execution. We believe that this combination of factors are the main reasons behind our consistent numbers that we are going to share with you. Going into slide five, we can show you our diagnostic medicine footprint. We have a network of B2C units formed by different brands that work in the premium, intermediate, and basic, entry level. We are also present in three states and in the Federal District capital of Brazil.
We've been growing through organic growth and acquisition, always focused on financial discipline and adding value to our shareholders. In our core of diagnostic medicine, we have to be B2B, supporting hospitals and different labs, strengthening our operations and the Brazilian healthcare system. The bottom part of the slide, we show you that Fleury Group offers services that complete the journey of care, going from prevention to continuing care, such as vaccination, checkup, healthcare checkup, and treatment and procedures through outpatient care in some specialties which are our priorities, which have been gaining more relevance due to the population aging. Slide six, we have a detailed understanding of our business units. Diagnostic medicine B2C has 33 regional brands and 570 patient service centers, amounting to 70% of our revenues in the first quarter, 2026 LTM.
We have mobile services amount to 8% of the total amount or 70 physical units, and this is a very important factor of efficiency of the units. B2B, 21% of our total revenues. We support over 8,000 partnering labs in different municipalities throughout the country, in addition to 35 hospitals served by us. We process a high number of tests, diluting then our processing costs. Novos Elos represent 9% of our revenues. five specialties, 10 brands, 29 units, reinforcing the integration between diagnostic, treatment, and support. Next slide, we can show two important objectives in our strategy: sustainable growth and diversity of revenue sources.
We've obtained CAGR of 13.7% year-over-year from 2012 up to today, showing from BRL 4.2 billion revenues in 2021 to BRL 9.2 billion in the first quarter 2026 LTM. Throughout this time, we have provided more and more diversified revenues with more participation of B2B and an increasing support of the Novos Elos. We've had a CAGR of 9.1% year-over-year and represents 25% of our total revenues, whereas other brands in São Paulo have gained also representativeness. Geographic expansion of B2C has been relevant, and today we have a very well balanced regionally with strong presence in Minas Gerais and Rio de Janeiro. This diversity of revenues and paying sources provides to our group more resilience and the capacity to capture more market share. In 2026, we are celebrating our 100-year anniversary.
As part of our celebrations, we are going to open this month our unit called Milestone 100. It's a unit placed in one upscale area of São Paulo, as we can see on slide nine. In addition to the complete portfolio of diagnostic medicine, our unit will also offer Fleury Life Care, a new exclusive service with coordinated integrated care. It was created to maximize the value and presence of Fleury in quality of life and longevity of premium audience. The target audience are people over the age of 35 years who are trying to have a multidisciplinary approach to have long, healthy lives. It's a trend which has been transformed into a huge market. The approach is based on six pillars, going from healthy diet to stress management, sleep, movement, exercise.
Is very customized, and each individual will just have an app with a multidimensional health map and a journey of care. By opening this unit with an investment of BRL 35 million and the launch of Fleury Life Care, we are taking one more step towards the future, providing medicine based on proactive prevention and customization. Creating Fleury Life Care is one more innovation of a company that year after year has going through transformation and growing responsibly and sustainably. We are now going to go into the financial highlights. Slide 11. Gross revenue reached BRL 2.4 billion, 10.1% growth over the first quarter last year. Our B2 C business has been showing throughout the quarters very good resilience, growth of 11.8% organically, and 15.1% considering acquisitions. Once again, of main highlights is Fleury brand, which is a leader in the premium segment of diagnostic medicine.
In the first three months of the year, the growth amounted to 12.1% compared with the same period last year. Being in place for 100 years, known by clients, by physicians, thanks to its excellence, our brand has shown a two-digit increase for three consecutive quarters. In São Paulo, all the other brands had an increase of 2%-8% or 14% if we consider organic growth, except for the effect of 25 units of Confiance from the region of Campinas which were acquired, and Lab São Lucas in Rio Claro concluded last year. In Rio de Janeiro, the growth amounted to 9.2%, and in Minas Gerais, it amounted to 19.7%. Excluding the effect of Hemolab incorporation, organic growth amounted to 15%. The quarter has also shown increase in B2B year-over-year.
The expansion of this business line amounted to 5.5%, a consequence of good performance of lab-to-lab practices, showing our increase in productive capacity in 2025, gaining new clients as labs. EBITDA amounted to BRL 606 million, 10.7% growth over the first quarter 2025, with EBITDA margin of 27.3% aligned with our year performance. Net income had 12.2% growth above the growth of revenues, reaching BRL 201.2 million. Net margin was 9.1%, 15 basis points above what was observed in the first quarter 2025. It is important to say that our ROIC has reached 17% in the first quarter 2026, 300 basis points above the second quarter 2023, when we have the combination of Grupo Fleury and Pardini businesses, showing our discipline in capital allocation.
Let me now hand it over to José Filippo, who is our CFO and IRO, who is going to make some further comments about our financial performance.
Thank you, Jeane. Good morning, everyone. Slide 12 will show you our gross revenue, 10.1% increase in the quarter, driven by our B2C units which had 15.1% growth. Our B2B unit increased 5.5%. Novos Elos had a reduction of revenues of 12.8% in the period. We are going to talk further about the performance of each unit in upcoming slides. Slide 13 shows our B2C performance. As we've shown you, we had growth of 15.1% in the quarter, a performance which is consistent in all different regions. Revenue amounted to BRL 1.7 billion. Organic growth was 11.8%, showing once again the strength of our brands. Growth excludes the effect of acquisitions of Confiance and Lab São Lucas and Hemolab in Minas Gerais. Recent movements in our strategy of M&A.
An important highlight of B2C unit was the increase of our brand Fleury, showing the expansion of number of encounters and increased market share gain. In slide 14, we can see gross revenues of B2B with an increase of 5.5%, showing good performance in lab-to-lab, which was offset by slower growth in hospitals. Next slide is slide 15. We show you the performance of our unit, Novos Elos. Gross revenue was BRL 194 million, or a 12.8% decrease, which can be explained by the strong basis for comparison through the application of four doses of high-cost medication in the first quarter last year. Slide 16, we can observe our gross profit, which reached BRL 628.1 million in the quarter. 9.8% increase compared to the same period last year. Gross margin was 28.3%, very much aligned with the previous year.
This result was impacted by some one-off effects on material, intermediation of tasks, personnel, and medical services. Slide 17 shows us operational expenses, which decreased in proportion to the revenues, reflecting our discipline in cost management. In 2026, we had BRL 260 million in operational expenses. Now, Slide 18, we can see EBITDA, BRL 606 million in the period, with a margin of 27.3%. Slightly increased the margin observed in the first quarter last year. Now, Slide 19, we can see our net income, total BRL 201.2 million in the period, 12.2% above the previous year. Net margin increased, reaching 9.1%, which is a result of the combination of growth, excluding tax, and a lower tax rate in the period. Slide 20, we can see CapEx. Our total investments amounted to BRL 60.6 million in the quarter, a decrease of 9.4% over the first quarter last year.
There was an increase of 65.2% in investments in new units, a decrease of 37% in IT and digital, and 48.3% decrease in renovation of equipment, diagnosis, and maintenance. Quarterly CapEx, in fact, influenced by the investment plan of the unit, and based on the last 12 months, amounted to 6% of the respective revenues. Next slide 21, shows operational cash flow, which was BRL 264.6 million in the quarter. A decrease of 17.9%. The first quarter normally shows seasonality with lower level of cash conversion compared to the total year. The total cash conversion rate of the company was equivalent to 43.7% of EBITDA in the quarter. Slide 22, we can see our ROIC, which reached 17% in the end of the quarter.
It's an indicator that increased 300 basis points since the second quarter, 2023, which showed our discipline in capital allocation and our constant pursuit for efficiency. Leverage remained 1x EBITDA, which is a comfortable level in a scenario of high interest rate, which gives us confidence to move on with sustainable growth. Slide 23. We closed the quarter with a cash position of BRL 2.267 million, which can cover our debts for the next 2.7 years. We keep on developing our indebtedness level with cost reduction and improvement of our rates. Our debt has an average cost of CDI plus 0.94%, average term of 3.1 years. Our rating is AAA BR. Before we starting our Q&A session, I would like to hand it back to Jeane Tsutsui for closing our presentation. Thank you very much.
Thank you, Filippo.
The strategy of Grupo Fleury, translated by the results that we have just shared and planned for the upcoming years, combines organic growth and inorganic growth, focusing on operational efficiency and differentiation of services provided to clients. The performance of the first quarter 2026 shows the solidity of our business plan based on diagnostic medicine, sustained by diversification of revenue sources, discipline in capital allocation, and focused on productivity and improvement of client experience. These characteristics keep us in a consistent growth position. Combined with operational efficiency, provides increase of offers that goes with all outpatient initiatives of a patient's journey. We are partners of healthcare insurance and other players in the area.
Our action in preventive medicine and the monitoring of chronic disease contribute actively to the sustainability of the system through products and services that engage patients in caring for health and align with the changes of aging population. Our unit 100 milestone, or Marco Cem, where we are starting our longevity service, it strengthen the position of Fleury as being the avant-garde of medicine provision. We have also maintained the discipline in the use of cost and expenses, leading to healthy margins and increase in net income for one more quarter. With our robust capital structure, we can take the best of good opportunities of inorganic expansion, always aligned with our strategy and culture and Following with economic, financial strong discipline.
The deliverables of Grupo Fleury based on science with reliability that we have been building with clients and the medical community throughout the country, combined with our ambition, discipline, and focus on excellence, have taken us to 100-year path, really building trust with all our stakeholders. Our commitment is to keep on creating and distributing value. In this very important moment of our history, we would like to thank all of those who have trusted on Fleury Group, especially our board of directors, the leaders of Grupo Fleury, the 5,000 physicians, and nearly 24,000 staff members who are part of Grupo Fleury. We would like to thank also our clients, shareholders, investors, and business partners. Together, we have built and renewed the legacy of a company which is a reference in healthcare industry in Brazil.
By doing that, we are moving towards, in 2026, being absolutely sure that science and confidence that have brought us that far will take us even further. We are now going to start the question and answer session. Thank you very much.
We are going to start now our Q&A session. To ask a question, please click raise hand. If you no longer want to ask the question, lower your hand. Our first question comes from Eduardo Resende with UBS.
Good morning, Jeane, Filippo. Thank you very much for the opportunity to ask questions. I have two questions from my side. First, I would like to understand more about this increase of organic growth that we've observed in the first quarter for brand Fleury and for intermediate brands. I would like to know what were the main drivers.
Could you please tell us more about your commercial strategy, whether there would be an improvement in credentialing or relationship with local payers? Do you believe the growth is coming through the mobile service or through the brick-and-mortar units? My second unit is to get your vision about lab-to-lab competition. We've seen some players in the industry with an expansion plan and investment plans which are kind of, really aggressive. I would like to know what you've been observing, as a result of the movements. Thank you all very much.
Hello, Eduardo. Thank you for the questions. Concerning organic growth, we can see B2C growing 12%, 11.8% precisely, and especially in the brand Fleury with 12.1%, and there are a number of factors that explain that.
First, the fact that it's 100-year-old brand that has maintained throughout time its quality, a strong relationship with the medical community. We are a reference in the area. We have also been performing some retrofit of our units to expand services in units of our brand in general. It started in Campinas, happened in Jundiaí, São Bernardo do Campo, and other cities. Not only we are obtaining new clients, we are also increasing the number of tests processed. In this quarter, this growth was observed more at the units. Mobile service is a very important leverage of services and growth, the growth has been observed more in the brick-and-mortar units for Fleury and for the other brands. I would like to reinforce the differentiation of brand Fleury. We maintain a level of service that is quite high, really unique experience.
Our Net Promoter Score is very high for brand Fleury. In addition, we are a reference for the medical community. Just for you to have an idea, in 2025, we had 75 events impacting 28,000 physicians. Physicians who are part of Fleury Group, there were 11,000 visits paid to them, so sharing content with them. Another aspect is the fact that our physicians discuss cases, provide medical support, and really solve the problems of our patients. This is something that has been maintained throughout the years, and we are reinforcing as something that sets us apart. We have a structured medical career. The medical management that we provide is a unique feature and something that we have built throughout the years. Concerning intermediate brands, we have observed significant organic growth in other brands in São Paulo. 14% organic growth actually in the main market.
São Paulo, Rio de Janeiro, where we know the number of beneficiaries has not been growing, but we maintain organic growth of 9.2%. In Minas Gerais, 15% organic growth really portray gain in market share. In general, as you've pointed out, our commercial strategy is to have partnership with payers, with healthcare insurance groups. This is something good. We try to get solutions, new products, but we have also been gaining market share in the key areas of Brazil. Concerning lab-to-lab competition. I would like to emphasize our growth in lab-to-lab, it's a robust growth. We had 8.2% growth in lab-to-lab overall. If we analyze support, it was a two-digit growth, and we also have a kind of smaller performance in hospitals where we've seen some reduced volume in the first quarter.
I think that in general terms, we are very well-prepared to keep on growing in lab-to-lab. We've expanded our productive capacity in 2025, and we plan to expand further our productive capacity. Throughout time, we have really been offering unique products, which is also a very important thing. We take the portfolio of innovation to partnering labs. We have a commercial team that is prepared to really attract new contracts, and we believe that we can also obtain market share in lab-to-lab. Even though there are other competitors in this market, there is an interesting trend, the capacity to have an expansion of the market through outsourcing. Therefore, five years ago, this level of outsourcing was 25%, whereas now it is 30%. We believe there is still room to keep on growing at lab-to-lab businesses. Thank you, Eduardo.
Thank you, Jeane, for your answer.
The next question comes by Flavio Yoshida with Bank of America.
Hello. Good morning, everyone. Thank you very much for the opportunity to ask questions. I have two quick questions here. First, Jeane has just talked about the retrofit in Fleury brand. Based on the square meters you published, there was an expansion of 5%, nearly 5% in square footage of Fleury or square meter. There was a 7% increase in revenue year-over-year in terms of square meter. It used to be stable for many years. Do you see it now as an alternative to expand the revenues for Fleury? Do you see it as a trend? I would like to understand also whether when you expand, you offer new services or whether you are just expanding existing services. First question. Second question concerns competition in diagnosis.
We've seen some competitors at more advanced levels in terms of turnaround. Some other competitors are going through more, let's say a bumpy situation. Have you been gaining more market share from those players in difficult performance? Do you also experience the competition of players who are going through a turnaround process as a more robust movement?
Thank you, Flavio. Yes, when we retrofit Fleury brand, we take the opportunity to expand our square meters. We did that at unit Jundiai, unit Campinas. We've just had an expansion there. This is something extremely important because we expand services with such movements. In our opinion, we can maintain a good pace of growth thanks to expansion. In addition, in the same square footage, I can give you one example. We've replaced the magnet of MRI in our unit Paraiso.
The same devices by re-having them, the sensor replaced, we have brought a new technology. We have the largest complex in Latin America with technology using AI with AIR Recon DL, which means enhanced productivity. We can have by 50% the reduction of uptake for tests. In the same piece of equipment of MRI, we can have 2x more tests. Two factors. Yes, whenever we have opportunities, we expand the square footage. It was a 5% increase and 7% increase in our revenues thanks to new services, and we also try to optimize our number of patients seen. In addition to the mobile footprint, with new routes, we can also expand. Another important point to make is that we also have innovation. For the past two years, we have launched nearly 900 new products and services in our company.
Not only new services, but also changes in methodology, showing our capacity to be always aligned with the avant-garde in medicine and health. Offering innovation, we are also offering unique solutions for physicians to solve the problems of their patients. Concerning competition in diagnostic medicine, we can see that throughout time we've maintained a level, and you can follow that. We've maintained consistency, investments in retrofitting units, consistency in expansion square footage, in medical career, in reputation of our brands, and level of services. I'm not going to talk about competition, but I'm going to tell you what we've been doing. Throughout time and consistently, we've been obtaining market share. We've been growing above the expected average growth in diagnostic medicine, which means about 20% of private healthcare provision.
If we get the volume of diagnostic tests from 2018 up to now, the CAGR would be about 5%, and our growth is above that, which shows our capacity to keep on maintaining good service to our clients, gaining market share. There is also the organic growth, and also inorganic growth. From now on, we are maintaining a very optimistic position. We believe we can keep on growing healthily, allocating our capital smartly. About 6% investment on a yearly basis in new devices, in expanding technical units, experience, in digital experience. We've made very significant expansions, and it helps us capture new clients who come through the digital channels.
We can see an improvement in level of our services, and we are going to keep on looking ahead with this optimistic perspective of growth, of bringing more volumes, reducing fixed costs, of making partnership with payers, and expanding services. We have 570 units in 14 states and, in addition, we are distributed all over Brazil through lab-to-lab, bringing a new volume of processed tests, and we can cover the whole country. The competitive landscape does not scares us. It's good to have good players. It strengthen the system at large. It strengthen the view of the capital market, seeing Brazil as an opportunity to receive more monies from abroad. We believe it all to be positive. Thank you, Flavio.
Thank you, Jeane Tsutsui. Great answer.
Next, question by Vinicius Figueiredo with Itaú. Good morning. Thank you for taking my question.
Let me building up on what Flavio has just asked concerning the expansion of Fleury brand. I would start to make a reference to what we've been observing in the industry at large, competitive market. Within it, we can see that good partners, historic partners such as Fleury brand, have been observing increase in recent months. I'd like to ask about the specific Fleury brand. Do you believe that the number of beneficiaries who have access to healthcare plans covered by Fleury, have they been increasing? This is an important point. I recall that at some time ago we asked you about the macroeconomic scenario, how it meant in terms of downgrading. At the same time, Bradesco, SulAmérica, Amil have been gaining market share in recent months as HMOs. Fleury brand is a very mature brand. We all know it.
If we maintain the space of healthy growth, do you believe that in upcoming quarters the mix would be more favorable in terms of EBITDA margin for the whole group?
Thank you for the questions, Vinicius. Fleury brand, as you pointed out, number of beneficiaries have shown some level of increase. Some players have been focused on premium segment, unique patient experience, and valuing players which still have very good medical reputation. Looking closely at our service level, we can also hear from medical indication, and this is a very strong parameter impacting Fleury brand. Some players have had an increase. You've mentioned the largest healthcare insurance companies in Brazil. They have been increasing.
Despite a more challenging macroeconomic landscape with high interest rates, we can see in São Paulo, and especially in the region where we have Fleury brand, the premium segment is very resilient. There is part of the population that really wants to be served by specific brands and services. They are very much concerned about their health. In May, we are launching, as I've told you, our Marco 100 unit with Fleury Life Care for people over the age of 35 who wants to be and maintain healthy. We are maintaining the strength of our brand. It is a very mature brand, it is still very full of vitality. Last year it had 7.7% growth. It's still a growth compared to other brands, which is part of your second question.
The intermediate level brands, they have growth rate which is higher than that of Fleury brand. The year in general, in 2025, Fleury brand grew 7.7%, but the other brands grew much more. In the first quarter, for example, Fleury grew 12.1 as a brand, but other brands had 28% growth just in São Paulo because we're having organic growth. Even in Minas Gerais, for example, the growth was nearly 20%. In Rio de Janeiro, 9.2%. The mix always influences our result. The mix of businesses and brands influence our margins. We also have always to analyze ROIC, because Fleury brand requires a level of investment, renovation, replacement of equipment, investment in units, is higher than the investments made in other brands and other services such as Lab- to- Lab.
We always analyze ROIC, return on investment. That's the most important thing. We have also been showing capital allocation discipline, maintaining an increasing ROIC, closing the quarter at 17% ROIC, 300 BPS over the first quarter 2023. We can see a B2C increasing somewhat more than Novos Elos and B2B. It tends to have a favorable mix, we have always to understand the brand mix within B2C. Other brands grow more than Fleury brand. However, we have a discipline in terms of cost and expenses. We even have a very healthy margin. 27.3% is a very healthy margin for the quarter. In our opinion, we are going to keep on obtaining the highest gains concerning margins. Of course, there is a combination with mix, as we have pointed out. Thank you for your questions, Vinicius.
Thank you for your answers.
The next question by Gustavo Miele with Goldman Sachs.
Hello, good morning. Thank you very much for taking my questions in this call. I have two questions. First, I want to understand what could have been the EBITDA margin dynamic in this quarter. There were two effects which attracted our attention. First, something positive, a contingency reverse, conversion in SG&A, 50 BPS. There was another effect on COGS, which was personnel cost, somewhat higher because of the increased provisioning of your profit sharing that you accounted for in the quarter. Do you believe that the two effects, one, cancel the other? Just to understand whether the reported margin it could be considered recurring for the next quarters. A second point concerns cash generation.
I know there is some seasonality here, but year-over-year, there was a decrease of nearly 20% in generation of operational cash because of working capital, of course. I would just validate the hypothesis. Is it a result of the calendar effect, carnival, at a different time of the year this year? If it's true, can we expect in the second quarter stronger cash generation? These are my two points.
Thank you, Miele. I'm going to answer your two questions. Concerning margins, we've had some factors that affected our margin in this quarter. You know we don't like adjusted margins. We really prefer to discuss topics independently. I would say the net impact was somewhat negative, the margin could have been better. Let me tell you about each of them.
In terms of cost, you've added some information, but I would like to make two points. Yes, provisioning of profit sharing was somewhat higher because of the curve of the first quarter, it would be expected, and we do it every quarter. There was an increase in revenues. It increased our variable cost, which is also expected to deal with the activity. There was one more point, which was the cost of healthcare insurance plans. We've made some adjustments, which is part of the monthly cost management. You've also said there was a reversion of the provision. These are topics we always analyze based on the laws, previous experience, and of course, to comply with the law and maintain a good relationship with the inspection agencies.
We've detected that the documents were okay. It's very likely that by doing that we had had some reduction in risks. I believe that the net results were negative because of that. With the margin for the quarter, it could have been better. This is what we can see. Once again, this is a result of management, of our controllership initiatives, of our cost measurement. There is no change in our profile whatsoever. We are keep on focusing on increasing productivity, diluting fixed costs as we grow. This has been our topic and our pace, so to speak. In terms of cash generation, the first quarter tends to be the worst in terms of cash generation. First, we pay the profit. We also have a number of taxes paid.
We have the expenses of beginning of the year, paying all the different taxes. The first quarter tends to have this characteristic. Over last year, there was a change in receivables date, but if you analyze receivables date, there was no change. one day more over the last quarter, the quarter last year, but no major changes. If you look, the first quarter of 2024, it was very similar to that of 2026. There are fluctuations, the dynamic of the first quarter, but it does not change our profile. Last year, we generated over BRL 2 billion in cash. In the first quarter, BRL 300 million. Cash generation in upcoming quarters tends to be stronger than in the first quarter. We don't expect anything different this year. Of course, we are very focused on cash generation. Cash discipline is very important.
Debt management, prioritization of investments, without really meeting the needs of businesses. Everything has been done. This is going to be our priority throughout the year.
Great. Very clear. Thank you.
Next question by Joseph Giordano with JP Morgan.
Hello. Thanks, everyone. I would like to talk about growth from a different perspective, a macro trend in the premium market with GLP-1 agents, for example. Can you see a different mix considering more comorbidities and focusing on these comorbidities when treated with GLP-1 agents, would that be a driver in the premium segments? Second question, going back to the market and M&A possibilities. Some players in the industry are going through rough time. Are you already anticipating anything that would make sense to you? What can you anticipate in terms of M&A? What do you expect to see in the upcoming quarters?
Good morning, Joseph. Thank you for the questions. When you talk about GLP-1 analog agents, we cannot specifically identify any changes in terms of mix.
I would like to remind you that Brazil, with this trend of really increasing life expectancy, we've been increasing significantly the percentage of obesity. 28%-30% of the population in Brazil is obese, which twice higher than the world average. Diabetes, which is very associated with weight gain, lack of physical exercise, about 12.9% of the population in Brazil has diabetes. Since 2006, there had been twofold increase of cases of diabetes in Brazil. All GLP-1 analogs, semaglutide and all the others, are gaining more and more relevance. Especially now that the patent has expired, they have been widely used therefore. In our opinion, there are two important aspects here. First, we monitor chronic patients, and the use of medication has been shown by studies as decreasing cardiovascular mortality if properly indicated, of course, and if followed by physicians.
Yes, there are chronic patients who are going to live longer, so increase in longevity, and the importance of offering outpatient monitoring. This is very much aligned with our positioning. We have prevention, monitoring of chronic cases, avoiding high cost events, which tend to be myocardial infarction, stroke. Of course, if properly indicated, GLP-1 analogs tend to improve that. Throughout time, we've been seeing our centers offering that go end to end. This is an important monitoring. When we analyze systems, when we see all the different indicators, there is a high percentage of diagnostic medicine because you are monitoring closely health status, and this is also associated with what we've been doing. We analyze services that consider longevity.
All the studies of GLP-1 analog show that these agents are effective when changing lifestyle, of course, which is something that we always advocate, including in our Life Care service, changing people's life habits so that the medication can be effective. In our opinion, this trend of monitoring patients with chronic outpatient disease will only increase, and this is why our position, what we do, makes sense, and of course, contributing to the sustainability of the system. Finally, concerning M&A, some players have a level of leverage which is kind of higher. We always consider all different possibilities. Our main focus of M&A have been on diagnostic medicine, where we can have integration, we capture synergies, but we should also consider the different size and elements. Our size is different than what we used to be in the past. In some regions we are widely represented.
In general, we have very good discipline and always willing to consider M&A opportunities. We have a capital structure that would quite easily accommodate that. We've been maintain this structure of M&A without impacting our leverage. They are mature assets bringing EBITDA in. We have to generate value, so it should be at the right price and with the appropriate synergy levels. It is our position. We are constantly analyzing all opportunities, and we only will decide for those that really make sense. Thank you.
Next question with Morgan Stanley, asked by Maurício Cepeda.
Good morning, Jeane, Filippo, Renato. Thank you. I have two questions. First, about oncology. You've considered going into oncology through Oncoclínicas, but you also have Croma. What are the plans you have for this market? What would be your competitive advantage?
Are you talking with the partners of Croma for this opportunity? How willing are you to move on? Second question about Novos Elos. We haven't seen an expansion of new clinics there or new patient centers. Why is it? Because of the regions where you are, or are you prioritizing just diagnostic medicine? Do you expect growth of this line by maturation of existing units expanding into other units? What do you expect?
Thank you. Oncology. Oncology is a very important specialty to healthcare because cases tend to increase. 700 new cases of cancer per year in Brazil. If we exclude skin and melanoma, there would be 500,000 new cases every year. We have a complete portfolio, and we serve a lot oncology for diagnostic purposes.
Not only the complete profile, but we also have some exclusive elements in genomics. We work with Hospital Israelita Albert Einstein for next generation sequencing, but a very strong research and development, developing new panels, especially for oncology. There are also other diseases, but tumor panels that really make a difference in terms of precision medicine to guide the best treatment. Always based on health economics studies. Another unique characteristic is that we have a service of clinical pathology and anatomical pathology throughout the country, high volume. We support different centers. Anatomical pathology is a very important element for oncology. We've considered businesses with Oncoclínicas. We got in and considered it for a while. We had an amendment to the agreement that had been signed before.
We were there just for something like 10, 20 years, just to have due diligence. We decided to leave the process. Croma is a joint venture with three players. It is in operation. There are four units, three in the city of São Paulo and one in the city of Rio de Janeiro, seeing patients. We strongly believe that there is expected growth in Croma. Throughout time, we will see it gaining more and more space. In our opinion, our characteristics are really unique in dealing in a specialty that makes sense to us. We are looking forward to expand our diagnostic portfolio, strengthen Croma, and our physicians are part of tumor board meetings and others. Concerning New Links, Novos Elos, there is a fluctuation of growth quarter-over-quarter. In the fourth quarter 2025, there was 24% growth in Novos Elos.
There was a decrease of 12%. It's because of high-cost medication. In other words, these infusions are highly impacted by the medication per se. In the first quarter 2025, there were four infusions of high-cost medication. In this quarter, there were none. Novos Elos, with its organic design, is moving on quite well in the specialties we prioritized. This is a maturation process of the investments made in new units. These units are open for credentialing. They have appropriate ramp-up. Of course, in the future, we expect to see opportunities. We probably should see expansion. As we've told you, we expect to have a ramp-up, reaching a level of profitability, and then make investments in further expansions. This is why we are now focused on diagnostic medicine and getting much more relevance.
Thank you.
The next question by Santander, Caio Moscardini.
Thank you for taking my question.
I'm sorry, we cannot hear you.
Is it any better? I have a question about growth.
Not loud enough. I apologize.
I have a question about growth, considering the calendar effect that you have had this year, especially in the second half of the year. I would like to understand what you are expecting. Could you get the question now?
Great. Thank you for repeating the question. I apologize we could not hear you the first time. Concerning growth, we've had a calendar effect from last year. The first half, there was smaller growth because of all the bank holidays. In the second half of the year, the growth was higher. The second half of the year, we'll probably have a broader base. In general, we are quite positive for our plan for 2026.
In addition to having a very similar calendar to last year's, in the second quarter, 0.8 days less in terms of operation, but we also have the effect of the World Cup during June and July. If it impacts the demand, it will just displace it, not put an end to it, right? More bank holidays in the first half of the year, it meant more volume in the second half of the year. I think 2026 has started quite well. We are very positive considering our growth. We've been making the necessary investments for expansion of services, for expansion of square footage. We also have the possibility of having FEMI with us. We are waiting for the final regulatory adjustments to incorporate the services. We have very positive perspective in addition to the differentiation that we've mentioned so far.
I strongly believe that our joint work of all our teams, the medical reputation, new physicians come to work with us, it all makes us very optimistic for the year of 2026. Even understanding that the second half of the year brings more challenges because it was stronger last year. For comparison basis, it might be challenging. We expect to get more and more market share and keep on growing.
Thank you, Caio.
Thank you.
With that, we close our question and answer session. I would like now to hand it back to Jeane Tsutsui for her closing remarks.
Thank you all very much for join us. We've started 2026, the year of our centennial anniversary, showing once again consistency and deliverable of results.
The company has been over a century of transformation, delivering medical technical excellence, innovation, strong organizational culture, and respect for the stakeholders, and we'll keep on working tirelessly, generating value to all of you. We are very confident on our strategy, always executed with discipline for outpatient services, and position as a reference in diagnostic medicine in Brazil. Our solid financial structure and clarity in our directioning makes us reinforce continuously the position of Fleury Group as a leader in healthcare in Brazil. Hope to see you in our next call. Our earning release call is closed now. Thank you all very much for participating. Have a great day. Thank you.