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The following is written in a well-known textbook of surgery:

Each gram of enteric carbohydrate provides 4.0 kilocalories (kcal) of energy. Parenterally administered carbohydrates (eg, intravenous dextrose) yield 3.4 kcal/g

What is the explanation for this?

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  • $\begingroup$ Is the textbook refering to the same type of carbohydrate in both case ? $\endgroup$
    – Frédéric
    Feb 3, 2018 at 17:01
  • $\begingroup$ The 3.4 refers to dextrose. What other carbohydrate is given iv? $\endgroup$
    – Graham Chiu
    Feb 3, 2018 at 20:20
  • $\begingroup$ @Frédéric unfortunately, this is not elaborated upon. $\endgroup$
    – playreader
    Feb 4, 2018 at 5:12
  • $\begingroup$ @GrahamChiu theoretically one can also administer fructose or inverted sugar syrup etc., but I don't think they are widely used. $\endgroup$
    – playreader
    Feb 4, 2018 at 5:37

2 Answers 2

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Parenteral carbohydrate is usually dextrose which is actually D-Glucose monohydrate. Monohydrate implies coupling with a water molecule, such that 1 gram contains a lower relative component of glucose, resulting in a lower kcal yield.

D-Glucose monohydrate

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The value of 4.0 kcal per gram of dietary carbohydrates is simply a convention used by the Atwater System, which took a single averaged value for each of the available macronutrients found in food. I believe it was meant to represent an average composition of dietary carbohydrates at the time.

However, not all carbohydrates have the exact same heat of combustion. In other words, the amount (weight) of carbohydrate needed to yield a specific amount of energy differs depending on the molecular form of the carbohydrate (1). More specifically, monosaccharides (glucose and fructose) have ~3.75 kcal per gram, disaccharides (sucrose and maltose) ~3.95 kcal per gram, and longer polysaccharides (starches) have 4.15 to 4.20 kcal per gram (2).

The reason for this is again caused by water, specifically the dehydration (loss of water) that occurs as a result of the condensation reaction which forms the glyosidic linkage between monosaccharide monomers (1). For each additional monosaccharide subunit added to a carbohydrate chain, a water molecule is lost (see the example below).

Demonstrated dehydration from condensation reaction between two monosaccharide subunits Image credit: https://ib.bioninja.com.au/

So...going back to the original example. The heat of combustion of anhydrous glucose is 3.75 kcal per gram. Glucose (180 g/mol) makes up ~ 90.9% of the weight of dextrose monohydrate (198 g/mol). So, take the heat of combustion of glucose (3.75 kcal/g) multiplied by it's relative proportion in composition of dextrose monohydrate (0.909) and you get 3.75 * 0.909 = 3.4 kcal per gram. The 4.0 kcal per grams of dietary carbohydrate is simply a convention derived from an average value based on work that's over a century old.

References:

1: FAO FOOD AND NUTRITION PAPER 77. Food energy - methods of analysis and conversion factors; Report of a Technical Workshop, Rome, 3-6 December 2002. FOOD AND AGRICULTURE ORGANIZATION OF THE UNITED NATIONS.

2: Agricultural Handbook No. 74. Energy value of food; basis and derivation. Merrill, A., Watt, B. USDA Agricultural Research Branch.

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