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Physiological aspects of energy metabolism and gastrointestinal effects of carbohydrates

European Journal of Clinical Nutrition volume 61, pages S40–S74 (2007)Cite this article

Abstract

The energy values of carbohydrates continue to be debated. This is because of the use of different energy systems, for example, combustible, digestible, metabolizable, and so on. Furthermore, ingested macronutrients may not be fully available to tissues, and the tissues themselves may not be able fully to oxidize substrates made available to them. Therefore, for certain carbohydrates, the discrepancies between combustible energy (cEI), digestible energy (DE), metabolizable energy (ME) and net metabolizable energy (NME) may be considerable. Three food energy systems are in use in food tables and for food labelling in different world regions based on selective interpretation of the digestive physiology and metabolism of food carbohydrates. This is clearly unsatisfactory and confusing to the consumer. While it has been suggested that an enormous amount of work would have to be undertaken to change the current ME system into an NME system, the additional changes may not be as great as anticipated. In experimental work, carbohydrate is high in the macronutrient hierarchy of satiation. However, studies of eating behaviour indicate that it does not unconditionally depend on the oxidation of one nutrient, and argue against the operation of a simple carbohydrate oxidation or storage model of feeding behaviour to the exclusion of other macronutrients. The site, rate and extent of carbohydrate digestion in, and absorption from the gut are key to understanding the many roles of carbohydrate, although the concept of digestibility has different meanings. Within the nutrition community, the characteristic patterns of digestion that occur in the small (upper) vs large (lower) bowel are known to impact in contrasting ways on metabolism, while in the discussion of the energy value of foods, digestibility is defined as the proportion of combustible energy that is absorbed over the entire length of the gastrointestinal tract. Carbohydrates that reach the large bowel are fermented to short-chain fatty acids. The exact amounts and types of carbohydrate that reach the caecum are unknown, but are probably between 20 and 40 g/day in countries with ‘westernized’ diets, whereas they may reach 50 g/day where traditional staples are largely cereal or diets are high in fruit and vegetables. Non-starch polysaccharides clearly affect bowel habit and so, to a lesser extent, does resistant starch. However, the short-chain carbohydrates, which are also found in breast milk, have little if any laxative role, although do effect the balance of the flora. This latter property has led to the term ‘prebiotic’, which is defined as the capacity to increase selectively the numbers of bifidobacteria and lactobacilli without growth of other genera. This now well-established physiological property has not so far led through to clear health benefits, but current studies are focused on their potential to prevent diarrhoeal illnesses, improve well-being and immunomodulation, particularly in atopic children and on increased calcium absorption.

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Acknowledgements

We thank Professor Nils-Georg Asp, Professor Arne V Astrup, Professor Nancy Keim, Dr Geoffrey Livesey, Professor Ian MacDonald, Dr Gabriele Riccardi, Professor A Steward Truswell and Dr Ricardo Uauy for the valuable comments they provided on the earlier manuscript. We also thank Dr Klaus Englyst and Dr R James Stubbs for helpful comments.

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Authors and Affiliations

  1. Institute of Human Nutrition, University of Southampton, Southampton, UK

    M Elia

  2. Department of Pathology and Neuroscience, Ninewells Hospital and Medical School, Dundee, UK

    J H Cummings

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  1. M Elia
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Correspondence to M Elia.

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Conflict of interest

During the preparation and peer review of this paper in 2006, the authors and peer reviewers declared the following interests.

Authors

Professor John Cummings: Chairman, Biotherapeutics Committee, Danone; Member, Working Group on Foods with Health Benefits, Danone; funding for research work at the University of Dundee, ORAFTI (2004).

Professor Marinos Elia: Since undertaking this work, Professor Elia has joined a committee to undertake a systematic review on the role of fibre in enteral tube feeding, with an unrestricted grant from Numico.

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Professor Nils-Georg Asp: On part-time leave from university professorship to be the Director of the Swedish Nutrition Foundation (SNF), a nongovernmental organization for the promotion of nutrition research and its practical implications. SNF is supported broadly by the food sector; the member organizations and industries are listed on the SNF home page (www.snf.ideon.se).

Professor Arne V Astrup: Research grants from Arla Foods, Danish Diary Association, Danish Meat Industry, Dutch Diary Association, Schulstad (Bakery), Unilever and Weight Watchers; speaker for Campina/Dutch Diary Association and Suikerstichting, Holland.

Professor Nancy Keim: None declared.

Dr Geoffrey Livesey: Director and shareholder of Independent Nutrition Logic Ltd, which also employs him as a consultant to work with commercial, governmental and educational establishments and to undertake research on commissioned works on matters regarding health and nutrition. Received payment or other support covering a period during 2002–2006, and has an expectation of support for the future from several commercial entities with an interest in the subject matter of the FAO/WHO scientific update, even if it does not convey any benefit to him personally, but which benefits his position or administrative unit, such as a grant or fellowship or payment for the purpose of financing a post or consultancy.

Professor Ian MacDonald: None declared.

Dr Gabriele Riccardi: None declared.

Professor A Steward Truswell: None declared.

Professor Ricardo Uauy: Scientific Adviser on a temporary basis for Unilever and Wyeth; Scientific Editorial/Award Adviser for Danone, DSM, Kelloggs, and Knowles and Bolton on an ad hoc basis.

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Elia, M., Cummings, J. Physiological aspects of energy metabolism and gastrointestinal effects of carbohydrates. Eur J Clin Nutr 61 (Suppl 1), S40–S74 (2007). https://doi.org/10.1038/sj.ejcn.1602938

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