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This is because abdominal fat accumulation is often influenced by a combination of factors: Insulin resistance Hormonal changes Thyroid dysfunction Reduced muscle mass Chronic stress Poor sleep quality Inflammation Sedentary work patterns When several of these factors overlap, losing visceral fat becomes considerably more difficult than losing a few kilograms through short-term dieting

doi: 10.1016/J.FREERADBIOMED.2018.08.007 38 HeijinkIHvan OosterhoutAJM