A previous study, which included 7,770 individuals from the Framingham Heart Study and the Malmö Diet and Cancer study, reported that obesity was associated with 6–20% lower NT-proBNP levels, compared to normal-weight status, and insulin resistance was associated with 10–30% lower levels of NT-proBNP, compared to insulin sensitive status (42). Here, NPPB is linked to obesity due to melanocortin 4 receptor deficiency.