减肥的时候是先减皮下脂肪还是内脏上的脂肪呢？

关于问题减肥的时候是先减皮下脂肪还是内脏上的脂肪呢？一共有 2 位热心网友为你解答:

【1】、来自网友【力训研究所肉崽】的最佳回答：

一、人体脂肪的消耗有明确的位置优先级：优先消耗内脏脂肪

与许多自媒体说的不太一样，人体的脂肪消耗并不是全身均匀的。虽然有少数研究得出减肥时消耗的内脏脂肪比皮下脂肪少[1][2]，但大多数研究指出『减肥过程中内脏脂肪比皮下脂肪消耗更多』。

Kelley 等人 2004 年在权威期刊《Diabetes Care》上发表了一篇论文，针对 39 名肥胖的 2 型糖尿病患者（平均体重 100kg，平均 BMI35）进行减肥实验（节食+药物），26 周受试者们减去的内脏脂肪（26%）明显高于皮下脂肪（15%）[3]。

原文截图

查了下《Diabetes Care》的因子高达 18.1，1 区的，比较可信。

查询页面

Ross 等人 2004 年招募了 54 名肥胖妇女（平均腰围 110CM，平均 BMI32），其中 15 人采用节食减肥，17 人运动减肥[4]。结果节食减肥组减去的内脏脂肪（20.8%）比腹部皮下脂肪（8.9%）更多；运动组减的内脏脂肪（30%）也比皮下脂肪多（16.9%）。

Subcuttaneous fat 是皮下脂肪，visceral fat 是内脏脂肪

除了这两个，还有大量关于节食的研究，都支持上述结论：

Weinser 等人 2001 年：23 名肥胖女性，26 周减去内脏脂肪 40.7%、皮下脂肪%33.1[5]；
Gower 等人 2002 年：19 名肥胖女性，26 周减去内脏脂肪 38.5%、皮下脂肪 30.3%[6]；
Pascuali 等人 2000 年：10 名肥胖女性，4 周减去内脏脂肪 8.3%、皮下脂肪 6.5%[7]；
Alvarez 等人 2005 年：6 名肥胖男性，13 周减去内脏脂肪 23.9%、皮下脂肪%17.7[8]；
Rice 等人 1999 年：9 名肥胖男性，16 周减去内脏脂肪 35%、皮下脂肪 25%[9]；
Weits 等人 1989 年：20 名肥胖女性，12 周减去内脏脂肪 15.1%、皮下脂肪 10.6%[10]；
Okura 等人 2002 年：14 名肥胖女性，14 周减去内脏脂肪 40%、皮下脂肪 28%[11]；
Fujioka 等人 1991 年：26 名肥胖女性，8 周减去内脏脂肪 33.3%、皮下脂肪 22.6%[12]；
Janssen 等人 1999 年：13 名肥胖女性，16 周减去内脏脂肪 28.6%、皮下脂肪 18.8%[13]；
Tchernof 等人 2002 年：25 名肥胖女性，14 周减去内脏脂肪 36.4%、皮下脂肪 23.7%[14]；
Thong 等人 2000 年：14 名肥胖男性，12 周减去内脏脂肪 25.2%、皮下脂肪 15.7%[15]；
Tiikainen 等人 2003 年：11 名肥胖女性，17 周减去内脏脂肪 23%、皮下脂肪 13%[16]；
Tiikainen 等人同年的另一项研究中 12 名肥胖女性，17 周减去内脏脂肪 29%、皮下脂肪 14%[16]；
ROSE 等人 2000 年：14 名肥胖男性，13 周减去内脏脂肪 28.1%、皮下脂肪 15.6%[17]；
Gambinery 等人 2003 年：7 名肥胖女性，26 周减去内脏脂肪 18.8%、皮下脂肪 8.4%[18]；

采用节食加运动的研究，结论也类似：

Park 等人 2004 年：47 名肥胖者，12 周减去内脏脂肪 23.8%、皮下脂肪 19.9%[19]；
Nakamura 等人 2000 年：60 名肥胖女性，13 周减去内脏脂肪 12.5%、皮下脂肪 8.9%[20]；
Park 等人 2005 年：36 名肥胖女性，12 周减去内脏脂肪 22.5%、皮下脂肪 14.8%[21]；
Okura 等人 2005 年：71 名肥胖女性，14 周减去内脏脂肪 39%、皮下脂肪 24%[22]；
Pare 等人 2001 年：45 名肥胖男性，52 周减去内脏脂肪 19.9%、皮下脂肪 10.1%[23]；

采用节食加减肥药物的研究，依然支持上述结论：

Kelley 等人 2004 年（奥利司他）：19 名肥胖者，26 周减去内脏脂肪 28%、皮下脂肪 16%[24]；
Tiikk 等人 2004 年（奥利司他）：24 名肥胖女性，21 周减去内脏脂肪 27%、皮下脂肪 14%[25]；
Kim 等人 2004 年（盐酸西布曲明）：28 名肥胖女性，12 周减去内脏脂肪 19.9%、皮下脂肪 16.5%[26]；
Kamel 等人 2000 年：17 名肥胖男性（盐酸西布曲明），26 周减去内脏脂肪 37.5%、皮下脂肪 24%[27]；19 名肥胖女性，26 周减去内脏脂肪 43.3%、皮下脂肪 20.1[27]；
Yip 等人 2001 年：20 名肥胖女性（盐酸西布曲明），24 周减去内脏脂肪%35.5、皮下脂肪%26.2[28]；

总之，不管是节食、运动、药物等一切减肥方式（还有胃部手术的没放上来），『减肥过程中内脏脂肪一般比皮下脂肪消耗更多』，所以人体消耗脂肪，是有部位的优先级的。

二、同样是人身上的肥肉，『脂肪』和『脂肪』是不同的

按颜色，人体脂肪可以分白色脂肪和棕色脂肪[29][30]，以及可以演化成棕色脂肪的米色脂肪[31]；按部位，脂肪有皮下、内脏、骨骼肌内脂、心肌脂等。

脂肪组织不仅是脂肪滴的容器，也是调节内分泌的器官。脂肪细胞中富含神经、血管和各种结缔组织[32]，能分泌多种细胞因子，调节食欲、能量代谢、免疫功能和生殖[33]；

皮下脂肪和内脏脂肪都是白色脂肪组织，但它们具有不同的作用（如内分泌）。皮下脂肪分泌瘦素，对健康可能更有益或者至少无害[34]，而内脏脂肪分泌各种促炎物质，如白介素 IL-6、C-反应蛋白 CRP[33]等，它们与代谢综合征有关[35][36][37][38][39][40]。

说个题外话，皮下脂肪和内脏脂肪的代谢特性差异，也造成了绝经前女性的代谢疾病率明显低于男性[41][42][43][44][45][46][47]；并且即便男性和女性的身体脂肪总量相等这种疾病率差异依然存在[48][49]。这主要因为雌激素把脂肪从『内脏』向『腿皮下』“转移”[50][51][52][53][54][55]，如果全身脂肪总量相同，男性的内脏脂肪量可能是女性的 2 倍[56]。

雌激素与脂肪分布

内脏和皮下脂肪脂肪的代谢特性也有不同。Virtanen 等人通过同位素标记的葡萄糖，证明了内脏脂肪对葡萄糖的摄取明显高于皮下脂肪[57]；Andersson 等人让受试者口服了带有同位素标记的甘油三酯，发现内脏脂肪（腹腔网膜）对甘油三酯的摄取显著高于皮下脂肪 50%以上[58]。

三、相对而言，内脏脂肪更容易被释放、被身体利用

这不是什么新鲜观点，早就是主流结论了。最典型的是 Robert 等人 2007 年发表在权威期刊《Diabetes》上的研究，用碳 14 同位素标记方法追踪来自内脏和非内脏脂肪酸[59]。

封面

这篇论文包含了 AB 两个研究。

A 研究中，内脏脂肪酸释放为 60±7%，非内脏脂肪酸释放 24±6%；
B 研究中内脏脂肪酸释放为 54±3%，非内脏脂肪酸释放 16±5%。

这些数据很好的说明了内脏脂肪具有更强的代谢活跃性，更容易被摄取和利用。

内脏脂肪酸释放（白）VS 非内脏脂肪酸释放（黑）

1991 年，Jensen 等人也用上述方法观察研究了 20 名女性（8 人上身肥胖/6 人下身体肥胖/6 人不肥胖）餐后脂肪酸的总释放情况[60]：

上身肥胖者的脂肪酸释放为 161±16 微摩/分钟；
下身肥胖者的脂肪酸释放为为为 111+/-9 微摩/分钟；
非肥胖者的脂肪酸释放为为 92+/-9 微摩/分钟。

同位素标记追踪的结果证明了腿部脂肪释放的脂肪酸明显少于内脏脂肪。Guo 等人也用类似方法，研究了 8 名上身肥胖和下身肥胖的女性餐后脂肪酸的代谢，发现了内脏脂肪和下半身堆积的脂肪，在餐后脂肪酸流量方面有显著差异[61]。

上身肥胖组的女性内脏脂肪酸释放流为 275±45 微摩尔/分钟；
下半身肥胖组的女性内脏脂肪酸释放流为 88±24 微摩尔/分钟。

这些数据证明了内脏脂肪的代谢流动性明显高于皮下脂肪，优先被释放，优先被消耗。

类似的研究不少[62][63][64][65]，结论从性质上相似，就不挨个细说了。总之，内脏脂肪酸的代谢活跃性相对于其他部位更强、更容易被释放出来利用。

这也解释了为什么，很多女生发现减肥初期肚子减得最明显，胸和屁股减得少一些，减肥之后形体得到了美化，腰臀比降低了。

四、内脏脂肪对脂解激素的敏感性更高

脂解激素，指的是人体处于禁食、运动或能量不足的状态时器官分泌一些激素。

这些激素从器官（肾脏、胰腺等）被释放，随血液运输到脂肪细胞，与其表面的受体结合，然后引发一系列反应，让脂肪细胞中的脂肪酸被释放出来，供各器官和大脑使用。

典型的脂解激素有胰高血糖素[66]、肾上腺素[67]和去甲肾上腺素[68]等；其中，肾上腺素被认为是最主要的一种。

脂解激素

内脏脂肪对脂解激素更敏感，跟受体有很大关系。

Jeong 等人研究了女性皮下（大腿/腹部）和内脏（腹腔网膜）脂肪，发现内脏脂肪细胞与皮下脂肪细胞表面的脂解激素（如肾上腺素）的受体位点数量、分布都有差异[69]：皮下脂肪细胞上的脂解激素（肾上腺素）受体β数量比α-2 要少，而内脏脂肪细胞上的β受体跟α-2 一样多。

1990 年，Arner 等人研究了 32 名非肥胖男女腹部和臀部脂肪细胞中β肾上腺素受体，发现腹部脂肪细胞上的β肾上腺素受体数量几乎是臀部脂肪细胞上的 2 倍，而且腹部脂肪细胞上的肾上腺素受体β1、β2、β3[70]十分活跃。这可在很大程度上解释内脏脂肪细胞对脂解激素的敏感反应和优先燃烧。

当然，既然有脂解，也就有抗脂解。顾名思义，抗脂解就是对抗脂肪分解，“把脂肪酸关在脂肪细胞里不让它跑出来被燃烧”。

Arner 等人还报道说，抗脂解激素（如胰岛素）的受体，在皮下脂肪更活跃[70]，但在内脏脂肪细胞中不活跃[71][72]。因此抗脂解激素很难把内脏脂肪制约在脂肪细胞中，结果内脏脂肪容易不受管控的逸出，在供能上优先级较高。

作为一个典型证据，Meek 等人对 26 人注射胰岛素后，腿部皮下脂肪组织的脂肪酸释放几乎完全被制止，而内脏脂肪依然在释放脂肪酸（虽然减少了 65%）[73]。

打个有趣的彼方，就像现在疫情来了要封闭清零：

脂肪酸像是居民，腿臀部和内脏就是不同的小区；
脂解激素有点像快递员，他们要让小区居民出来拿快递；
抗脂解激素就是负责封闭小区的居委会，不让小区居民出来；
腿臀部小区居民比较听居委会的话，对外卖的诱惑视若无睹，老老实实待在家里；
内脏小区居民不太听居委会话，对快递员很热情，总是跑到外面去拿快递。

五、内脏脂肪的供能优先级：地理位置优势

我们已经知道，在禁食/饥饿/运动/能量不足期间，肾脏/胰腺等器官分泌脂解激素作用于脂肪细胞，释放脂肪酸出来供身体使用。

但是释放的脂肪酸，并不是直接到了各种器官，而是先去肝脏。Michele 等人报告[74]在禁食/能量不足状态下，脂肪细胞释放的脂肪酸（至少大部分）先到肝脏，再到肌肉和其他组织。脂肪细胞为什么会开始释放脂肪酸？我们刚刚解释过，脂解激素刺激。

把两张图拼起来就是这样：

粗略框架

这样，整个流程就大体上完整了。所以我们应该清楚，脂肪组织释放的脂肪酸，并不是直接去了肌肉/其他器官，而是先去了肝脏，在肝脏合成 TG（甘油三酯），然后再送往肌肉/其他器官。

因为肝脏是能量代谢的中心[74][75]。

这和我们的主题（内脏脂肪供能的优先级）有什么关系？答案是，相比大腿而言，内脏脂肪离肝脏近，向肝脏供能便捷——门静脉[76][77][78]。

门静脉

虽然这种说法听起来有点像地摊文学，但确实在许多科学文献都有提及：『门静脉理论』[79][80]。即：因为网膜、肠系膜等内脏脂肪组织的血管直接连入门静脉，可以将大量的脂肪酸释放到门静脉中，门静脉的脂肪酸浓度可显著高于动脉脂肪酸浓度，使肝脏沐浴在高浓度的脂肪酸流中[81][82]。

Soren 等人早在 2004 年就证明[83]：男性和女性受试者的内脏脂肪越多（越胖），肝脏得到的脂肪酸中，来自内脏脂肪的比例就越高。

男性和女性受试者从内脏脂肪组织脂解产生脂肪酸，向肝脏输送的百分比

Soren 等人的研究是一个强有力的证据，证明了餐后内脏肥胖的人的肝脏暴露于更高浓度的游离脂肪酸。这也解释了为什么内脏脂肪在供能上，相对于大腿/皮下脂肪，具有更高的优先级。

总之，减肥一定是先减内脏脂肪、或者说内脏脂肪动用比例较大的。

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