“…45 Third, although diabetic subjects with visceral obesity (high level of VFA) often have dyslipidemia and multiple complications including DN, hypertension, and CHD than those without (low level of VFA), they may pay more attention to their illness, and employ various strategies including tight control of blood glucose, blood pressure, and blood lipids and other risk factors, and change the composition of the diet (eating more fresh vegetable and fruit, and fish), all of which were significantly associated with decreased visceral fat and improvement of overall nutritional status and peripheral nerves function. [47][48][49][50] Fourth, it is a plausible explanation that inadvertent weight loss may occur in individuals with longstanding inadequate diabetes control as consequences of multiple systemic insults or comorbidities. 51 There have been a few studies reporting that in individuals with progressive metabolic deterioration due to lack of diabetes control, obviously elevated resting metabolic rate would lead to ongoing increased energy expenditure, which may have a long-term impact on body weight or body composition regulation that appears as sustained unintentional weight loss.…”