Digestion and Absorption of

Nutrients
DR NYONGESA
MBCHB II YEAR 2024
Outline

 Macronutrients
 Micronutrients
 Minerals
 Vitamins
Carbohydrates

 Largest source of calories

 Cheapest source of calories
 3 kinds:
 Monosaccharides
 Oligosaccharides
 Polysaccharides
 Starch
 accounts for more than 1/3 of dietary intake
 Composed of amylose and amylopectin
Digestion

 A-amylases:  Brush border enzymes:

 attack internal a 1,4 glucose bonds; spare 1 1,6  Sucrase: sucrose to glucose and fructose
linkages  Lactase: Lactose to glucose and galactose
 Yield maltose, maltotriose and a –limit  Glucoamylase: maltotriose/maltose to
dextrins
 Trehalase : trehalose to
 Salivary amylase: Initiates digestion in the
mouth. Partially active in the stomach
 Pancreatic amylase: activity dependant on
presence of Ca and CL- in duodenum
 Further breakdown of starch into
oligosaccharides
Absorption

Glucose and galactose

• Apical absorption using SGLT 1: specific, saturable, against concentration gradient,
secondary active

Fructose:
• GLUT 5 facilitated diffusion down a concentration gradient

Basolateral: GLUT 2: Facilitated diffusion of above molecules into portal

circulation
Colon

 Carbohydrates entering colon are salvaged  Functions of SCFA:

 Caloric intake
  Trophic effect on colonic epithelium
Colonic bacteria ferment to produce short
chain fatty acids: Butryate, propionate, acetate  Combat inflammation
 Maintaining acid base equilibrium
 SCFA are absorbed by nonionic diffusion or
by cotransport with Na/H
Lipids
Lipid

 Dietary fats include TGs, phospholipids and cholesterol

 Some lipids have polar moieties; but most are non polar

 In aqueous solutions, most lipids form micelles or lipid bilayers

 Tgs form main dietary fat in human diet

Digestion
Mouth and stomach
 Lingual lipase form Von Ebner glands, active
even in acidic gastric environment
 Gastric lipase: secreted by peptic cells.
Functions in acidic pH, acts solely on Tgs to
release medium chain fatty acids
 Especially important in newborns
Small intestine
 Most lipid digestion happens here
 Colipase facilitate lipolytic activity of p lipase
 Pancreatic lipase: lyses lipid to free fatty acids
and monoglycerides
 Products interact with bile acids/PLPs and
cholesterol to form micelles
 Phospholipase A2
 Cholesterol esterase: cleaves esters off
Absorption

 Products of Tg breakdown are transported into enterocytes by fatty acid translocase

 FFA with <10 carbon bonds are water soluble hence transported into portal circulation
 FFA>10-12 C bonds are resynthesized and packaged in ER and GB as chylomicrons
 These are released on basolateral membrane by exocytosis into lymphatics
 Cholesterol: uptake is energy dependent by a specific NPC-L1 carrier
Protein digestion
Digestion
 Ingested proteins supply essential amino acids
 Proteins are hydrolysed into di-, tri- peptides
and amino acids
 Stomach: Pepsinogen released by chief cells
is activated by acidic pH into pepsin
 Pepsin releases peptides and AA from proteins
 Chymosin/rennin: prominent in neonatal
period
 Duodenum:
 dependant on pancreatic proteases
 Enterokinase activates trypsinogen
 Active at near neutral or alkaline pH
 Classifed into
 Endopeptidases: trypsin, chymotrypsin and
elastase
 Exopeptidases: carboxypeptidase A and B
Absorption

 Products diffuse to the brush border

 Digestion is completed by various brush border peptidases: amino-, carboxy-,endo, di-
 Tri and dipeptides are transported into enterocytes by PepT1 tranporter, requires H+
instead of Na+
 Some di and tripeptides are hydrolysed intracellularly
 Transport of AA is coupled to inwardly directed Na+ gradient
 Absorbed AA are either metabolized into proteins or exported into portal circulation.
Minerals
Calcium

 Body has 1kg of calcium, 99% is in bones and teeth

 Dietary intake averages 400-1000mg per day

 Absorption is inhibited by PO4 and oxalates

 Constitutive fecal loss is offset by absorption

 Before absorption, Ca must be solubilised

Calcium absorption

Active means: Passive means

 Through channels/carriers on brush border  Occurs throughout small intestine
 TRPV6 channel for facilitated diffusion down  Via paracellular route
electrochemical gradient
 Not under vitamin D
 Intracellular: free calcium binds on calbindin D,
which transports to basolateral border
 Basolateral border: calcium is extruded into
circulation against electrochemical gradient by
Ca ATPase and Na/Ca exchanger
 Vitamin D3: Upregulates TRPV6, calbindin D,
and PMCA 1b(Ca ATPase)
Iron

 Incorporated into Hb (70%), myoglobin(3%) and rest into ferritin

 Participates in electron transfer during oxidative phosphorylation
 No efficient physiologic means for excretion
 Daily absorption: 1mg for men, and 2mg for women
 Amount of iron absorbed is 3-6% of amount ingested
 Most dietary iron is in ferric form, must be solubilised by gastric secretions
Absorption
 Duodenum: major site of absorption
 Fe3+ reduced to Fe2+ by ferrous reductase
 DMT-1 at brush border facilitates entry
 Heme: transported by heme carrier protein1
 Heme oxygenase-2 releases Fe2+
 Fe2+ can be stored as ferritin intracellularly
 Or converted into Fe3+ by hephaestin before
export by ferroportin
Regulation of iron absorption

 Hepcidin: synthesized by liver

 Regulates iron metabolism
 Increased when iron stores are adequate
 Signals:
 Suppresses release of iron from ferritin, and gut absorption of iron
Copper

 Essential nutrient
 Must in divalent form before absorption
 CTR1 : apical mebrane transporter
 Metallithionein: intracellular binding protein for copper
 ATP7A: copper transporter located on basolateral membrane
 Ceruloplasmin, albumin and AA: complex with copper during circulation
 ATP7B: After copper is removed from circulation, it is secreted into bile by this
transporter
Fat soluble vitamins

 Vitamins ADEK: dependant on presence of pancreatic juice and bile salts for absorption
 Released from conjugates by gastric acid
 Carboxyl esterases cleave off esters to relases free vitamins
 These are incorporated into micellar formation
 At enterocytes: simple diffusion or transporters facilitate entry.
 They translocate to SER for incorporation into chylomicrons or VLDLs
Water soluble vitamins

 Apart from folate and vitamin B12, rest of vitamins have carriers that are sodium
cotransporters
 Easily absorbed
Vitamin B12/cobalamin

 Serves as a coenzyme in homocysteine: methionine methyl transferase

 Manufactured by microorganisms
 Not present in vegetables or fruits
 Dietary vit B12 is bound on proteins
 Stomach:
 B12 binding proteins haptocorrin and IF compete to bind
 Haptocorrin is digested in duodenum
 Released B12 binds on If
Absorption of vit B12

 Occurs at terminal ileum

 B12 – IF complex binds on cubam receptor for
receptor mediated endocytosis
 In enterocyte, cobalamin dissociates from
complex in lysosomes
 MRP1 transports cobalamin to the basolateral
space
 Vit B12 then binds on transcobalamin II for
distribution
Concept checks
Summary