Chapter 43

After studying this chapter, you should be able to:

• Describe the digestion and absorption of carbohydrates, lipids, proteins, vitamins, and minerals.
• Explain how energy requirements can be measured and estimated and how measuring the respiratory quotient permits estimation of the mix of metabolic fuels being oxidized.
• Describe the consequences of undernutrition: marasmus, cachexia, and kwashiorkor.
• Explain how protein requirements are determined and why more of some proteins than others is required to maintain nitrogen balance.

In addition to water, the diet must provide metabolic fuels (mainly carbohydrates and lipids), protein (for growth and turnover of tissue proteins, as well as a source of metabolic fuel), fiber (for bulk in the intestinal lumen), minerals (containing elements with specific metabolic functions), and vitamins and essential fatty acids (organic compounds needed in smaller amounts for other metabolic and physiologic functions). The polysaccharides, triacylglycerols, and proteins that make up the bulk of the diet must be hydrolyzed to their constituent monosaccharides, fatty acids, and amino acids, respectively, before absorption and utilization. Minerals and vitamins must be released from the complex matrix of food before they can be absorbed and utilized.

Globally, undernutrition is widespread, leading to impaired growth, defective immune systems, and reduced work capacity. By contrast, in developed countries, there is excessive food consumption (especially of fat), leading to obesity, and the development of diabetes, cardiovascular disease, and some cancers. Deficiencies of vitamin A, iron, and iodine pose major health concerns in many countries, and deficiencies of other vitamins and minerals are a major cause of ill health. In developed countries nutrient deficiency is rare, although there are vulnerable sections of the population at risk. Intakes of minerals and vitamins that are adequate to prevent deficiency may be inadequate to promote optimum health and longevity.

Excessive secretion of gastric acid, associated with Helicobacter pylori infection, can result in the development of gastric and duodenal ulcers; small changes in the composition of bile can result in crystallization of cholesterol as gallstones; failure of exocrine pancreatic secretion (as in cystic fibrosis) leads to undernutrition and steatorrhea. Lactose intolerance is the result of lactase deficiency, leading to diarrhea and intestinal discomfort when lactose is consumed. Absorption of intact peptides that stimulate antibody responses causes allergic reactions; celiac disease is an allergic reaction to wheat gluten.

The digestion of carbohydrates is by hydrolysis to liberate oligosaccharides, then free mono- and disaccharides. The increase in blood glucose after a test dose of a carbohydrate compared with that after an equivalent amount of glucose (as glucose or from a reference starchy food) is known as the glycemic index. Glucose and galactose have an index of 1 (or 100%), as do lactose, maltose, isomaltose, and trehalose, which give rise to these monosaccharides on hydrolysis. Fructose and the sugar alcohols are absorbed less rapidly and have a lower glycemic index, as does sucrose. The glycemic index of starch varies between ...

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