However, careful interpretation is necessary because numerous factors, such as sex, age, blood pressure, kidney function, and obesity, seriously affect BNP levels (Maries et al., 2013; Madamanchi et al., 2014, Nakagawa et al., 2019, Goetze et al., 2020, Ohashi et al., 2022). Here, NPPB is linked to obesity due to melanocortin 4 receptor deficiency.