Chapter 26

After studying this chapter, you should be able to:

• Understand how nutrients are delivered to the body and the chemical processes needed to convert them to a form suitable for absorption.
• List the major dietary carbohydrates and define the luminal and brush border processes that produce absorbable monosaccharides as well as the transport mechanisms that provide for the uptake of these hydrophilic molecules.
• Understand the process of protein assimilation, and the ways in which it is comparable to, or converges from, that used for carbohydrates.
• Define the stepwise processes of lipid digestion and absorption, the role of bile acids in solubilizing the products of lipolysis, and the consequences of fat malabsorption.
• Identify the source and functions of short-chain fatty acids in the colon.
• Delineate the mechanisms of uptake for vitamins and minerals.
• Understand basic principles of energy metabolism and nutrition.

The gastrointestinal system is the portal through which nutritive substances, vitamins, minerals, and fluids enter the body. Proteins, fats, and complex carbohydrates are broken down into absorbable units (digested), principally, although not exclusively, in the small intestine. The products of digestion and the vitamins, minerals, and water cross the mucosa and enter the lymph or the blood (absorption). The digestive and absorptive processes are the subject of this chapter.

Digestion of the major foodstuffs is an orderly process involving the action of a large number of digestive enzymes discussed in the previous chapter. Enzymes from the salivary glands attack carbohydrates (and fats in some species); enzymes from the stomach attack proteins and fats; and enzymes from the exocrine portion of the pancreas attack carbohydrates, proteins, lipids, DNA, and RNA. Other enzymes that complete the digestive process are found in the luminal membranes and the cytoplasm of the cells that line the small intestine. The action of the enzymes is aided by the hydrochloric acid secreted by the stomach and the bile secreted by the liver.

Most substances pass from the intestinal lumen into the enterocytes and then out of the enterocytes to the interstitial fluid. The processes responsible for movement across the luminal cell membrane are often quite different from those responsible for movement across the basal and lateral cell membranes to the interstitial fluid.

### Digestion

The principal dietary carbohydrates are polysaccharides, disaccharides, and monosaccharides. Starches (glucose polymers) and their derivatives are the only polysaccharides that are digested to any degree in the human gastrointestinal tract. Amylopectin, which typically constitutes around 75% of dietary starch, is a branched molecule, whereas amylose is a straight chain with only 1:4α linkages (Figure 26–1). The disaccharides lactose (milk sugar) and sucrose (table sugar) are also ingested, along with the monosaccharides fructose and glucose.

###### Figure 26–1

Left: Structure of amylose and amylopectin, which are polymers of glucose (indicated by circles). These ...

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