Overnutrition and inactivity can lead to obesity, impaired glucose tolerance, dyslipidemia, and hypertension, a cluster of diseases known as the metabolic syndrome. Insulin resistance and dysregulation of adipocytokines are the fundamentals of this syndrome. It is well documented that advancing age is associated with increased body fat and blunted insulin action, however, centenarians, who are the best model of successful aging, had a preserved insulin sensitivity and better adipocytokine profiles. It is also demonstrated that adipocytokine dysregulation can lead sarcopenia and frailty in the oldest old. These observations suggested that preservation of adipose endocrine function by means of lifestyle modification may be potentially important for maintaining health and function and promoting survival at an extremely old age.