Our study investigated body composition and body fat distribution in healthy centenarians. Body composition, body fat distribution, and resting metabolic rate (RMR) were studied in 40 adult subjects aged < 50 y, 35 aged subjects > 75 y, and 15 healthy centenarians aged > 100 y. Body composition was determined by bioimpedance analysis, body fat distribution was calculated as waist-hip ratio (WHR), and RMR was calculated by using the Arciero-Poehlman formula. Healthy centenarians had a cognitive impairment and degree of disability greater than aged subjects. Despite such differences, fat-free mass (FFM) and RMR were not different in centenarians compared with aged subjects but were lower than in adult subjects. In contrast, healthy centenarians had a WHR lower than that of aged subjects but not different from that of the adult subjects. After the level of physical activity and degree of disability were adjusted for, FFM (44 +/- 2.7 and 40 +/- 1.1 kg; P < 0.05) and RMR (6757 +/- 761 and 5891 +/- 723 kJ/24 h; P < 0.05) were significantly higher in healthy centenarians than in aged subjects, respectively. Independent of age, sex, body weight, degree of disability, level of physical activity, and fasting plasma triiodothyronine, there was a strong correlation between RMR and FFM (r = 0.50, P < 0.05) in healthy centenarians. In conclusion, healthy centenarians had a lower FFM and higher body fat content than aged subjects. Level of physical activity and degree of disability seem to be the major determinants for explaining such differences.