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Introduction\nFood\tprovides\tenergy\tand\tbuilding\tmaterials\tfor\tcountless\tsubstances\tthat\tare\tessential\tfor\tthe\ngrowth\tand\tsurvival\tof\tevery\thuman\tbeing.\tThis\tsection\topens\twith\ta\tbrief\toverview\tof\tthe\tdigestion,\nabsorption,\ttransportation,\tand\texcretion\tof\tnutrients.\tThese\tremarkable\tprocesses\tconvert\tcomplex
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molecules\tin\tfood\tinto\tindividual\tnutrients\tready\tto\tbe\tused\tin\tmetabolism.\tMacronutrients\t(proteins,\nfats,\tand\tcarbohydrates)\teach\tcontribute\tto\tthe\ttotal\tenergy\tpool,\tbut\tultimately\tthe\tenergy\tthey\nyield\tis\tavailable\tfor\tthe\twork\tof\tthe\tmuscles\tand\torgans\tof\tthe\tbody.\tThe\tway\tnutrients\tbecome
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integral\tparts\tof\tthe\tbody\tand\tcontribute\tto\tproper\tfunctioning\tdepends\theavily\ton\tthe\tphysiologic\nand\tbiochemical\tprocesses\tthat\tgovern\ttheir\tactions.\tIt\tis\tnow\tknown\tthat\tthese\tmetabolic\tprocesses\nare\n\taltered\tin\tthe\tpresence\tof\tacute\tand\tchronic\tinflammation.\tUnderstanding\tthe\tbiomarkers\tand
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other\tindicators\tof\tinflammation\tis\ta\tcritical\tcomponent\tof\tnutrition\tassessment.\nFor\tthe\thealth\tprovider,\tnutrition\tassessment\tis\tthe\tfirst\tstep\tin\tthe\tnutrition\tcare\tprocess.\tTo\nimplement\ta\tsuccessful\tnutrition\tplan,\tthe\tassessment\tmust\tinclude\tkey\telements\tof\tthe\tpatient’s\nclinical,\tmedical,\tand\tsocial
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1\nIntake:\tGastrointestinal\ndigestion,\tabsorption,\tand\nexcretion\tof\tnutrients\nKelly\tA.\tTappenden,\tPhD,\tRDN,\tFASPEN\nKEY\tTERMS\namylase,\tpancreatic\namylase,\tsalivary\nbrush\tborder\tmembrane\nchelation\ncholecystokinin\t(CCK)\nchyme\ncolonic\tsalvage\ncrypts\ndiffusion,\tfacilitated\ndiffusion,\tpassive\ndysbiosis\nenterocytes\nenterohepatic\tcirculation\nenterokinase
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dysbiosis\nenterocytes\nenterohepatic\tcirculation\nenterokinase\nenzymatic\thydrolysis\nepithelial\tcells\ngastrin\nghrelin\nglucagon-like\tpeptide\t2\t(GLP-2)\ngut–brain\taxis\nisomaltase\nlactase\nlipase,\tgastric\nlipase,\tpancreatic\nlipase,\tsalivary\nlipolytic\tenzymes\nmaltase\nmicelle\nmicrobiome\nmicrobiota\nmicrovilli\nmotilin\nmucosa\nparietal\tcells\npepsin\nperistalsis
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microvilli\nmotilin\nmucosa\nparietal\tcells\npepsin\nperistalsis\nprebiotic\nprobiotic
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model\tof\t“ingestion,\tdigestion,\tand\tutilization.”\tIn\tthis\tmodel,\tconsideration\tis\tgiven\tto\teach\tstep\tto\nidentify\tall\tareas\tof\tinadequacy\tor\texcess.\tIf\tthere\tis\tany\treason\twhy\ta\tstep\tis\taltered\tfrom\tphysical,\nbiochemical,\tor\tbehavioral-environmental\tcauses,\tthe\tnutrition\tprovider\tmust\tselect\tan\tappropriate
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nutrition\tdiagnosis\tfor\twhich\tintervention\tis\trequired.\tIntake\tand\tassimilation\tof\tnutrients\tshould\nlead\tto\tnutritional\tand\toverall\thealth.\nThe\tgastrointestinal\ttract\nThe\tGIT\tis\tone\tof\tthe\tlargest\torgans\tin\tthe\tbody,\thas\tthe\tgreatest\tsurface\tarea,\thas\tthe\tlargest\nnumber\tof\timmune\tcells,\tand\tis
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number\tof\timmune\tcells,\tand\tis\n\tone\tof\tthe\tmost\tmetabolically\tactive\ttissues\tin\tthe\tbody.\tThe\tunique\nstructure\tof\tthe\tGIT\tenables\tample\tnutrient-processing\tcapacity\tin\thealthy\thumans.\tThe\thuman\tGIT\nis\tabout\t9\tmeters\tlong,\textending\tfrom\tthe\tmouth\tto\tthe\tanus\tand\tincluding\tthe\toropharyngeal
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structures,\tesophagus,\tstomach,\tliver\tand\tgallbladder,\tpancreas,\tand\tsmall\tand\tlarge\tintestine\t(\nFig.\n1.1\n).\nFIG.\t1.1\nThe\tdigestive\tsystem.\nThe\tGIT\tis\tdesigned\tto\t(1)\tdigest\tthe\tmacronutrients\tprotein,\tcarbohydrates,\tand\tlipids\tfrom\ningested\tfoods\tand\tbeverages;\t(2)\tabsorb\tfluids,\tdigested\tmacronutrients,\tmicronutrients,\tand\ttrace
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elements;\t(3)\tprovide\ta\tphysical\tand\timmunologic\tbarrier\tto\tpathogens,\tforeign\tmaterial,\tand\npotential\tantigens\tconsumed\twith\tfood\tor\tformed\tduring\tthe\tpassage\tof\tfood\n\tthrough\tthe\tGIT;\t(4)\ncoordinate\ta\tresponse\tto\tmicrobes\tand\tantigens\twith\tthe\tsystemic\timmune\tsystem,\tresulting\tin
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most\tof\tthe\tunabsorbed\tmaterial\tis\tof\tplant\torigin.\tCompared\twith\truminants\tand\tanimals\twith\ta\nvery\tlarge\tcecum,\thumans\tare\tconsiderably\tless\tefficient\tat\textracting\tenergy\tfrom\n\tgrasses,\tstems,\nseeds,\tand\tother\tcoarse\tfibrous\tmaterials.\tHumans\tlack\tthe\tenzymes\tto\thydrolyze\tthe\tchemical
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bonds\tthat\tlink\tthe\tmolecules\tof\tsugars\tthat\tmake\tup\tplant\tfibers.\tHowever,\tfibrous\tfoods\tand\tany\nundigested\tcarbohydrates\tare\tfermented\tto\tvarying\tdegrees\tby\tbacteria\tin\tthe\thuman\tcolon;\tthis\nprocess\tcan\tcontribute\t5%\tto\t10%\tof\tthe\tenergy\tneeded\tby\thumans.\nThe\tstructure\tof\tthe\tsmall\tintestine
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crypts\nand\tfingerlike\tprojections\tcalled\t\nvilli\n\t(\nFig.\t1.2\n).\tThese\tcrypt-villus\tunits\tare\tlined\twith\ta\tsingle\tlayer\nof\t\nepithelial\tcells\n,\tmany\tof\twhich\tare\t\nenterocytes\n\tthat\tcontain\teven\tsmaller\tcylindrical\textensions\ncalled\t\nmicrovilli\n.\tThe\tepithelial\tcells\tlining\tthe\tintestinal\ttract\thave\ta\tlife\tspan\tof\tapproximately\t3\tto
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5\tdays,\tand\tthen\tthey\tare\tsloughed\tinto\tthe\tlumen\tand\t“recycled,”\tadding\tto\tthe\tpool\tof\tavailable\nnutrients.\tAs\tthe\tcells\tmigrate\tfrom\tthe\tcrypt\talong\tthe\tvillus,\tthey\tmature\tand\tdevelop\tgreater\ndigestive\tand\n\tabsorptive\tfunction.\nFIG.\t1.2\nStructure\tof\tthe\thuman\tintestine\tshowing\tcrypt-villus\tarchitecture\tand\tblood\tand\tlymph\tvessels.
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