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S50
Physiological aspects of energy metabolism
M Elia and JH Cummings
especially marked for food items containing a high proportion
of ‘fibre’ and certain types of protein, both of which may
be prominent in weight-reducing diets (Brown et al., 1998). A
modification of the Atwater general system that takes into
account the presence of unavailable carbohydrate in foods
(Livesey, 1991) has the advantage of overcoming the inaccuracy
of the Atwater general system, while avoiding the complexity of
the Atwater-specific system (Merill and Watt, 1973).
Terminological and methodological issues in carbohydrate
analysis are also important, due to the varied nature of the
techniques that are in use. These are dealt with in other
papers in this consultation (for example, see Measurement of
dietary carbohydrates for food tables and labelling by Englyst
et al., 2007). All carbohydrates can be determined by direct
analysis. Carbohydrate ‘by difference’ (total carbohydrate
unavailable carbohydrate) requires assumptions about the
fate of carbohydrates in the colon that cannot always be
predicted because this will, for example in the case of
starches, be dependent on the physical form of the food,
cooking and cooling, the degree of ripeness and nature of the
starch granule. Therefore, ‘by difference methods’ should not
have a place in carbohydrate analysis. Compared to the
direct method, the indirect method (‘by difference’) has the
effect of increasing the cEI, DE, ME and NME values of
available carbohydrates by B1 kJ/g. As already suggested, the
direct analysis is preferable (FAO, 1998), although this may
pose practical problems in developing countries with poor
access to analytical facilities. Finally, it should be remembered
that food labelling applies to food items not diets, and
that some foods may acquire different properties and
different energy values before being ingested. For example,
starch in potato can become resistant if it is cooked and
allowed to cool before being ingested (Englyst and
Cummings, 1987). In contrast, RS changes into ordinary of
starch during the maturation of bananas, which occurs whilst
their skins turn from green to yellow. Although these processes
will affect DE, ME and NME values in different ways, food
labelling cannot adequately take them into account.
The idea that bioenergetic inefficiency results in heat
production is not new, since it was already in existence in
early part of the twentieth century. It is also well known that
agents such as 2,4-dinitrophenol, which uncouple oxidative
phosphorylation, produce a considerable amount of heat.
Therefore, measurement of energy expenditure (heat production)
does not necessarily reflect useful metabolic or
external work done. The idea of establishing bioenergetic
equivalence of different macronutrients has obvious attractions
to food labelling. The NME (but not the ME) system is
based on the concept that macronutrients contribute
equivalently to energy balance and energy requirements
irrespective of food composition. The FAO acknowledges
that the Atwater-specific and general systems do not take
into account Hine, which is relevant to calculations of energy
requirements, and in the annexe of its report on food energy
(FAO, 2003), it provides two tables to address this issue
(Table 3.1 provides correction factors when ME intakes are
European Journal of Clinical Nutrition
being matched with requirements and Table 3.2 expresses
food needs as the ‘food NME requirement’).
The current labelling of carbohydrates (and more broadly
foods in general) is unsatisfactory because the ME system is
used for some carbohydrates (usually the most abundant
carbohydrates, such as starch and sucrose), but the NME
system is used for polyols and polydextrose in many regions
(and in the same regions that use the ME system). It would
seem more logical to use the same energy system for all
carbohydrates, and indeed for all other nutrients. It has been
argued that since NME values are only B96% of ME values
(NMEB ¼ 0.96 ME), it makes little difference which system is
used (especially since energy intake cannot generally be
assessed with an accuracy of less than 4%). On the other
hand, values for specific foods can be affected by considerably
more (up to 30%; for example, those rich in certain
types of protein and ‘fibre’ are used for weight reduction).
These errors may fall outside the range permitted by
legislation in the European Union (Commission, 2006). In
addition, by comparison with the NME system different diets
of the same ME value can be constructed that would result in
differences of 10–15% (for example, diets rich in NSP or
protein, as for example energy-restricted diets in which
normal protein intake represents a high proportion of
energy). Therefore, it would seem sensible to use a consistent
method that is sound at all levels, so that the consumer, the
nutritionist and the researcher are not misled. In addition, it
should be remembered that physiological considerations
that make a difference of only a few percent have already
been taken into account in devising food energy systems, for
example DE of the diet is greater than ME by a few percent,
which is similar to the extent to which ME is greater than
NME. Furthermore, as indicated above, early inaccuracies in
energy values for ‘fibre’/NSP and polyols have been
corrected, even though the changes make only a few percent
difference to the total energy value of the diet. An early
example of implementing small changes involves the Atwater
energy factors that replaced the earlier Rubner factors,
for example 2.5% difference for combustible energy of
carbohydrate. Another argument is that errors associated
with measurement of dietary intake and potential errors
associated with the development of RS after cooking are
sources of greater error than the use of the ME system instead
of the NME system. This poses a problem for analysts and
those compiling food composition tables, However, it is
reasonable to suggest that food-labelling policy should aim
to establish a system that avoids bias as far as possible using a
practical user-friendly system. It has also been argued that an
enormous amount of work would have to be undertaken to
change the current ME system into an NME system. On the
other hand, if an attempt is to be made to establish either a
consistent ME or an NME system, some changes will be
necessary. If this involves conversion to a consistent NME
system, the additional changes may not be as great
as anticipated, as the following three equations (round
numbers) indicate.