been found in intestine, SGLT1. In humans the activ-
ity and expression of this transporter are maintained
by the presence of luminal nutrients, as suggested
by the brush border experiments in fed and fasted
animals. The low-affinity SGLT2 is only found in
kidney, and its kinetics can be explained by reducing
the Na
þ
/glucose coupling from 2:1 to 1:1. SGLT1 is a
glycoprotein of 75 kDa with 14 membrane-spanning
regions, existing as a homotetramer in the membrane.
The single N-linked carbohydrate side chain is not
required for function. The relative specificity of the
transporter is the same as that previously character-
ized for the active membrane transport system,
i.e., d-glucose>a-methyl-d-glucose>d-galactose>3-
O-methyl-d-glucopyranose>>>l-glucose. It is clear
that SGLT1 accounts for all of the active glucose
transport, because mutations in this protein account
for the entire phenotype in patients with hereditary
glucose-galactose malabsorption.
0023 Glucose absorbed into the enterocyte is trans-
ported across the basolateral membrane by facilitated
diffusion mediated by GLUT2. This high-capacity
transporter has 12 membrane-spanning regions, and
can transport fructose as well as glucose. Although
glucose is metabolized by the enterocyte, the pre-
ferred energy substrates for this cell are amino acids,
preferentially glutamate, glutamine, and aspartate. In
the presence of amino acids, intestinal metabolism of
glucose is decreased. After exit from the cell, glucose
enters the portal vein, and is delivered to the liver and
peripheral tissues (mostly muscle), in which tissues
the glucose is extensively metabolized.
Fructose Absorption
0024 Fructose transport occurs by an Na
þ
-independent,
saturable system of lower capacity than that for glu-
cose or galactose. The capacity for fructose absorp-
tion in humans is limited, although theoretical
estimates of absorption capacity are relatively high.
GLUT5 mediates all or most of fructose transport
across the apical membrane of enterocytes. Human
GLUT5 transports fructose alone, but the rat homo-
log recognizes both glucose and fructose. However,
absorption of fructose in humans can be inhibited by
the presence of glucose. Thus, it is possible that a
second apical fructose transporter exists. Unlike the
relatively wide tissue distribution in humans (Table 3),
rat GLUT5 is expressed largely in the small bowel,
kidney, and brain. Fructose is poorly metabolized in
the enterocyte, and is transported from the cell by
basolateral GLUT2, and in humans by basolateral
GLUT5 as well. Expression of GLUT5 is increased in
animals fed fructose. This adaptation accompanies
the increase in sucrase-isomaltase found after fructose
or sucrose feeding.
Short-chain Fatty Acid Absorption
0025Short-chain fatty acids are the major nutrients pro-
duced by bacterial fermentation. The usual starting
substrates are carbohydrates. In humans the fermen-
tation products are produced and absorbed in the
colon. Both small bowel and colonic mucosa readily
absorb unionized short-chain fatty acids. The trans-
porter responsible for this uptake is most likely a
member of the monocarboxylate-type transport pro-
teins, perhaps by the anion exchanger AE2 found in
apical membranes of intestinal mucosal cells. The
anion gradient across the apical membrane is butyr-
ate>bicarbonate>propionate>chloride. The capacity
of this transporter is much lower than that for
SGLT1, but is still sufficient to achieve some salvage
of malabsorbed carbohydrate.
0026Unlike hexoses in the small intestine, short-chain
fatty acids are partly metabolized in the colonic cells,
and appear to be a major nutrient source. Most of the
fatty acids are metabolized intracellularly to CO
2
.
Estimates of the contribution of short-chain fatty
acid metabolism to the basal metabolic requirement
vary from low (1–2% in the pig and 6–9% in
humans) to high (30–40% in the rabbit). The import-
ance of this pathway in humans increases in patients
with sugar malabsorption, when delivery of non-
absorbed sugar is increased to the colonic lumen.
See also: Carbohydrates: Classification and Properties;
Dietary Fiber: Properties and Sources; Fructose;
Glucose: Glucose Tolerance and the Glycemic
(Glycaemic) Index; Lactose; Starch: Structure,
Properties, and Determination; Resistant Starch;
Sucrose: Dietary Importance; Sugar: Refining of
Sugarbeet and Sugarcane
Further Reading
Alpers DH (1994) Digestion and absorption of carbohy-
drates and proteins. In: Johnson LR (ed.) Physiology of
the Gastrointestinal Tract, 3rd edn, pp. 1723–1749.
New York: Raven Press.
Klein S, Cohn SM and Alpers DH (1999) Gastrointestinal
function. In: Shils ME, Olson JA, Shike M and Ross AC
(eds) Modern Nutrition in Health and Disease, 9th edn,
pp. 605–629. Baltimore: Williams & Wilkinson.
Loo DDF, Zeuthen T, Chandy G and Wright EM (1996)
Cotransport of water by the Na
þ
/glucose cotransporter.
Proceedings of the National Academy of Science of the
USA 93: 13367.
Levin RJ (1999) Carbohydrates. In: Shils ME, Olson JA,
Shike M and Ross AC (eds) Modern Nutrition in Health
and Disease, 9th edn, pp. 49–65. Baltimore: Williams &
Wilkinson.
Thomson AB and Wild G (1997) Adaptation of intestinal
nutrient transport in health and disease. Digestive
Diseases and Sciences 42: 453–469, 470–488.
886 CARBOHYDRATES/Digestion, Absorption, and Metabolism