Chapter 1Nutrition Basic –Intake:

Digestion, Absorption, Transport, &

Excretion of Nutrients
Stacia Whittaker MPH, RDN
September 05, 2022
Textbook – Krause’s
READ
 Mahan, L. K. and Escott-Stump, S. Krause’s Food, Nutrition and Diet
Therapy, 12th ed. W.B. Saunders Co., Philadelphia 2008. ISBN:
978141603408
 Know key terms on pg 2

 Read FOCAL POINT pg 20 in textbook

Digestion,
Absorption,
Transport &
Excretion of
Nutrients
The Gastrointestinal Tract
(GI)
 Primary role (GI) tract :
(1) Extract macronutrients (proteins, carbohydrates, lipids) water, and ethanol from
ingested foods and beverages

(2) Absorb necessary micronutrients and trace elements;

(3) Serve as a physical and immunological barrier to microorganisms, foreign

material, and potential antigens consumed with food or formed during the
passage of food through the GI tract.

GI tract also participates in many other regulatory, metabolic,

and immunologic functions that affect the entire body.
The Gastrointestinal Tract
(GI)
 Depending on the nature of the diet consumed, about 90-97% of food is digested
and absorbed; most of the unabsorbed material is of plant origins.

 Body lacks the enzymes to hydrolyze the chemical bonds that link the molecules
of sugars that make up plant fibers.

 Fibrous food and any undigested carbohydrates are fermented to varying degrees
by bacteria in the human colon, but only 5% to 10% of the energy needed by the
human can be derived from this process (Engylst and Englyst, 2005)
GI Tract
 Largest organ in the body with the largest surface area

 Extends from the mouth to the anus

 Includes the oropharyngeal structures, esophagus, stomach, liver and

gallbladder, pancreas and small and large intestine
 Secretion, digestion, absorption, and cellular replication
GI Tract
 Human intestines is about 7m (23 feet) long and configured in a patterns of
folds, pits, and fingerlike projections call villi
 Villi are lined with epithelial cells and even smaller, cyclindrical extensions called
microvilli

 The cell lining the intestines have a life span of 3-5 days

 The health of the body depends on a healthy and functional GI tract.

 Depends on a constant supply of food rather than consumption of large

amounts of foods interrupted by prolonged fast
Brief Overview of Digestive &
Absorptive Processes
 Mouth: Chewing reduces size of food particles, which are mixed
with salivary secretions and prepared for swallowing
 Small amount of starch is degraded by salivary amylase

 Esophagus: Transport food and liquid from the oral cavity and
pharynx to the stomach.
 Stomach: food is mixed with acidic fluids and proteolytic and
lipolytic enzymes
 Small Intestines: Most digestion takes place here
Brief Overview of Digestive &
Absorptive Processes

 Small Intestines: first 100cm a flurry of activity occurs resulting in the

digestion and absorption of most of the food ingested.
 Presence of food in the small intestines stimulates the release of
hormones that in turn stimulates the production and release of
powerful enzymes from pancreas, small intestines, liver and
gallbladder.
 Reduction of starches = small-molecular-weight carbohydrates
 Proteins = small-to-medium peptides.
 Dietary fats = visible globules of fat = triglycerides = free fatty acids and
monoglycerides
Brief Overview of Digestive &
Absorptive Processes
 Enzymes from the brush border of the small intestines further reduce
the remaining carbohydrates to monosaccharides and peptides to single
amino acids, dipeptides, and tripeptides


 [Link]
Enzymes in Digestion
 Digestion accomplished by hydrolysis under direction of enzymes
 Enzymes are synthesized in specialized cells in the mouth, stomach,
pancreas, and SI and released into the lumen

 Cofactors such as hydrochloric acid, bile, and sodium bicarbonate

support the digestive and absorptive processes
 No additional digestive enzymes are secreted from the large intestines
 Except for fiber and some carbohydrates

 Proteins, lipids and carbohydrates are broken down to absorbable

units by digestive enzymes

 Absorption is the passage of nutrients across the intestinal wall

Neural Mechanisms
 GI movement – contraction, mixing, propulsion of lumal content is the
coordinated activity of enteric nerves, extresic nerves, endocrine cells, and
smooth muscle
 Intrinsic system and external system

 Mucosal receptors in the gut wall are appropriately sensitive to the

composition of the chyme and lumen distention
 Neurotransmitters and neuropeptides with small molecular weights
signals nerves to contract or relax muscles, increase or decrease fluids
secretions, or change blood flow
Neural Mechanisms
 GI largely regulates its own motility and secretory activity

 GI disease – enteric nervous system may be overestimated, resulting in

abnormal secretion, altered blood flow, increase permeability, and altered
immune function
 Sympathetic neurons, which are activated by fear, anger, and stress – slows
transit of GI
 Parasympathetic nerves innervate specific areas of the alimentary tract

 Sight and smell of food stimulates vagal activity and secretion of acid from
parietal cells
Neuropeptide Hormones
 Gastrin

 Secretin

 Cholecystokinin (CCK)

 Glucagon-like peptide 1 (GLP-1)

 Glucose-dependent insulinotropic polypeptide (GIP)

 Motilin

 Somatostatin
Neuropeptide Hormones
 Gastrin – stimulates gastric secretions and motility
 Secreted from endocrine “G” cells in the antral mucosa of the stomach.
1. Distention of antrum after a meal
2. Impulses from vagus nerve – smell or sight of food
3. Presence in the antrum of secretagogues (fermented alcoholic beverages,
partially digested proteins, caffeine or food extract)

 Chief cells release pepsinogen; receptors on smooth muscle increase gastric

motility
Neuropeptide Hormones
 Secrertin – released from “S” cell
 Opposes the action and secretion of gastrin
 Stimulate the pancreas to secrete water and bicarbonate into the
duodenum – inhibits gastric acid secretion and emptying

 Cholecystokinin(CCK) release in the presents of protein

and fat
1. Stimulate the pancreas to secrete enzymes
2. Stimulate gallbladder contraction
3. Increase colonic and rectal motility
4. Slow gastric emptying
5. Increase satiety
Neuropeptide Hormones
 Glucagon-like peptide 1 (GLP-1) and Glucose-
dependent insulinotropic polypeptide (GIP)
 Release from intestinal mucosa – meals rich in glucose and
fats; stimulate insulin synthesis and release

 Motilin – release by the cells of the upper small intestines

in response to bile and pancreatic secretion into duodenum
 Somatostatin – release by D cells in the antrum and
pylorus
 Inhibitory and antisecretory
 Treat GI disorders
 [Link]
Gastrointestinal Tract
 • MOUTH: teeth, tongue, salivary glands

 • ESOPHAGUS: involuntary muscles, mucous

 • STOMACH: 3 muscle layers, fundus, pyloris

 • SMALL INTESTINE: duodenum, jejunum, illeum

 • LARGE INTESTINE: cecum, asscending, transverse, decending, sigmoid,

rectum
Digestion in the Mouth
 Teeth grind and crush foods - Chewing: breaking down large pieces of food to
much smaller ones.
 Food is moistened and lubricated with saliva; three pairs of salivary glands – the
paratid, submaxillary, and sublingual – 1.5 L
 Lysozyme to kill bacteria

 Release of enzymes stimulated by presence of food; food is mixed with salivary

enzymes:
 amylase – digestion of starch
 lingual lipase – digest some fat; minimal

 Bolus is pass to the pharynx under voluntary control - swallowed.

 Peristalsis moves food into the stomach

Esophagus
 Muscular tube to carry the bolus from the mouth to the stomach.

 Glottis provides marvelous control to keep food from going to the lungs

 Moved by peristaltic contractions

 Low esophageal sphincter above entrance to the stomach prevents reflux of

gastric content
 Pyloric sphincter is the distal portion of the stomach – regulate exit of gastric
content and prevents backflow of chyme from duodenum into stomach
Digestion in the Stomach
 Food particles are mixed with gastric secretions by wavelike contractions

 Upper portion of the stomach (fundus), to mid-portion (corpus) and then the
antrum and pylorus.
 2000-2500ml gastric juice secreted daily

 HCL, protease, gastric lipase, mucus, intrinsic factor and gastrin

 Pepsin – pepsinogen – HCL

 Pepsin active only in acid environment of the stomach – some protein

change size and shape
Digestion in the SI
 Primary site for digestion of food and nutrients

 21- 30 feet long and the main site for CHO and FAT digestion.

 Duodenum (8”)

 - pancreatic juices and bile drain into this part

 - NaHCO3 neutralizes the HCl from the stomach
 - Enzymes: Amylase works on CHO, lipase on FAT and trypsin on
PRO, Bile: emulsifies and homogenizes FAT molecules
Digestion in the SI
 Duodenum 0.5 m long – most digestion happens here

 Jejunum 2-3 m long(upper 40%): secretes digestive juices containing more

enzymes for the breakdown of FAT, CHO, and PRO.
 Ileum 3-4 m long; (lower 60%): mixes the food mass further, moves it
downward and accomplishes the final breakdown of food.
 Majority of assimilation occurs here in the villi and brush border of the walls
into the thoracic duct.
 Vitamins and minerals require no chemical changes to be absorbed.
Digestion of SI
 Pancreatic lipase – lipid-digesting enzymes

 Proteolytic enzymes – includes trypsin and chymotrypsin, carboxypeptidase,

aminopeptidase, ribonuclease, and deoxyribonuclease.
 Chyme - takes 3-5 hours to digest a meal in the stomach.
 Pyloric sphincter controls stomach emptying.
 Meal content regulates emptying to a large degree: fat slows the process, CHO
speeds it.
Structure & Function SI
 Characteristic folds in its surface called valvulae conniventes

 Fingerlike projections called villi

 Covered by microvilli or brush border

 Combination = enormous absorption surface of 200 to 300m2

 Lamina propria
Assignment 1
 Prepare and submit a tri-fold leaflet on celiac disease
 Definition
 Symptoms & Causes (include foods to avoid)
 Intervention (include foods allowed)
 Self-management
 Reference

 Include graphics/pictures where necessary

Structure & Function
 Emulsification of fats in the small intestines - free fatty acids and b-
monoglycerides.
 Micelles – complexes of free fatty acids, monoglyceride, and bile salts

 Unstirred water layer (UWL)

 Cholesterol absorption may be accomplished through both passive and

facilitated transfer that involve a protein transport system
Absorption Mechanisms
 Active transport
 Input of energy and transport protein
 Moving against an energy gradient
 Glucose, Na, K, Mg, P, Fe, Cl, iodide, and amino acid

 Passive diffusion
 Simple diffusion
 Facilitated diffusion
Large Intestine
 Absorption remaining water and salts, bacteria fermentation, synthesis of a
small amount vitamins, storage, and excretion

 1.5 m long (cecum, colon, and rectum)

 Mouth-to-anus transit time may vary form 18 – 72 hours

Bacteria Action
 400 species of microorganisms

 Lactobacillus organisms chief component in infants GI before solid foods

 HCL, pepsin, and bile serves as a germicidal agent

 Helicobacter pylori acid-tolerant bacterium – gastritis and ulceration

 Escherichia colii

 Bacterial action highest in LI

Colonic Salvage of Malabsorbed
Energy Sources and SCFA
 Disposal of residual substrates through production of SCFAs is called colonic
salvage
 Carbohydrates are limited in humans

 Excess amounts of carbohydrates and fermentable fiber in the colon can

cause increase gas production, abdominal distention, bloating, pain, increase
flatulence and decrease colonic pH
 Large amounts of poorly digested sugars or carbohydrates consumed at once
causes diarrhea
 Recommended dietary fiber 24 – 38 g daily from fruit, vegetables, legumes,
seeds, and whole grains
Colonic Salvage of Malabsorbed
Energy Sources and SCFA
 Recommended daily consumption of dietary fiber assist in
the following ways:

1. Maintain health of the cells lining the colon

2. Prevent excessive intracolonic pressure
3. Prevent constipation and maintaining a stable and healthful
microbial population
Digestion & Absorption of Specific
Type of Nutrients

 Most dietary carbohydrates are consumed in the form of: Starches,

disaccharides and monosaccharaides
 Starches or polysaccharides largest components carbohydrates
 Large molecules composed of straight or branched chain sugar molecules
 Amylopectins
 amylose

 Salivary amylase (ptyalin) – neutral or slightly alkaline pH; hydrolyzing a

small amount of starch molecules into smaller fragments
Digestion & Absorption of
Specific Type of Nutrients
 Most carbohydrate digestion occurs in the proximal small intestines

 Pancreatic amylase breaks the large starch molecules at α1-4 linkages to

create maltose, maltrotriose, and “alphalimit” dextrins remaining from the
amylopectic branches.
 Maltase, sucrase and lactase and isomaltase

 Maltose , sucrose, lactose, and isomaltose

Proteins
 Intake of protein in the Western world 50 -100g daily – mainly from animal
sources
 Digestion begins in the stomach

 Proteoses, peptones and large polypeptides

 Inactive pepsinogen is converted into the enzyme pepsin when contact HCL
and other pepsin molecules.
 Digestion takes place in the upper portion of small intestines but continues
throughout GI tract
Proteins
 End product of protein indigestion are absorbed as both amino acids and small
peptides
 Some transporters are sodium- and/or chloride-dependent,

 Absorbed peptides and amino acids are transported to the liver via the portal
vein for metabolism by liver and are released into the general circulation.
 Absorption is completed by the time protein reaches the jejunum

 Small amount of amino acids in the epithelial cells are used for synthesis of
new protein
Lipids
 97% of dietary lipids are in the form of triglycerides and the rest are in the
form of phospholipids and cholesterol
 Entrance of fat and protein into small intestines stimulates the release of
CCK and enterogastrone inhibit gastric secretions and motility, thus slowing
the delivery of lipids.
 Large fatty meal remain in the stomach for 4 hours or longer

 Bile reduces the fat globules into tiny droplets

 Gall bladder, about 1 L of bile is secreted daily in response to the stimulus of

food in the duodenum and stomach
Lipids
 Micelles: free fatty acids and monoglycerides produce by digestion from
complexes with bile salt
 Facilitate passage of the lipids through the watery environment of the intestinal
lumen to the brush border

 95 - 97% of ingested fat is absorbed into lymph vessels

 Increase motility, intestinal mucosal changes, pancreatic insufficiency, or the

absence of bile can decrease absorption of fat
Vitamins & Minerals
 Various factors affect the bioavailability of vitamins and minerals

 Chelation

 8 – 9 L of fluid is secreted from the GI tract and serves as a solvent, a vehicle

for chemical reactions, and a medium for transfer of several nutrients
 Large amounts of iron or zinc may decrease the absorption of copper
 Phytates and oxalates impair the absorption of both iron and zinc

 Minerals are transported in blood bound to protein carriers e.g. transferrin

binds with iron
Factors Affecting Digestion

 Psychologic factors –
 appearance, smell, and taste of food in addition to emotional states, have an impact
on digestion
 Increase secretion of GI hormones, fluids, and enzymes increase muscular activity
of the GI tract
 Strong odors, noxious stimuli, and very strong emotions may induce nausea and
vomiting.
 Ageing affects digestions through impaired protein turnover rate, reduced anabolic
hormones production, and inadequate intake
Food Processing
 Freezing, preserving, microwaving, baking and frying can alter solubility,
microbial counts, structure and digestibility of foods and even increase the
formation of potentially harmful foods.
 Ascorbic acid and folate can be destroyed by prolonged cooking

 Cooking softens dietary fiber

 Enrichment replaces several of the lost nutrients but not the dietary fiber or
phytochemicals
Reference
 Mahan, L. K. and Escott-Stump, S. Krause’s Food, Nutrition and Diet
Therapy, 12th ed. W.B. Saunders Co., Philadelphia 2008.