Knowledge and practice of folic acid supplementation and impact of income level on awareness among women of child-bearing age in Saudi Arabia

Purpose: To investigate the knowledge of Saudi women (pregnant and non-pregnant) about the significance of folic acid (FA) supplementation and to determine how income levels affects this knowledge and its implementation. Methods: The study was conducted among women of child-bearing age attending Al-Hada Armed Forces Hospital and Khaliss General Hospital (both in Riyadh, Saudi Arabia) for pregnant women and Omm Al-Qura University in Makkah Governorate (Saudi Arabia) for non-pregnant women. A structured questionnaire was used to collect socio-demographic data and to analyze levels of FA knowledge, including general awareness, proper timing of its use, information source, FA benefits, and the perils of FA deficiency. A chi-square test was performed to test the differences between variables. Results: Analysis of the survey data revealed that 81.1 % of non–pregnant and 91.1 % of pregnant women were aware of the term, FA (p < 0.05). Moreover, 71.1 % of the pregnant compared to 35.6% of non-pregnant women knew that this supplement must be taken before becoming pregnant and this difference was statistically significant (p < 0.05). For pregnant women, doctors and previous pregnancies were the main sources of FA knowledge, while mass media was the most frequently reported source for non-pregnant women (p < 0.05). Income level was not associated with FA knowledge in either group. Conclusions: This study illustrates a deficiency in the knowledge and consumption of this important micronutrient in women of childbearing age, the population most in need of this information. Nutrition education should be provided to increase the understanding and practice of FA supplementation periconceptionally and during pregnancy

The human liver microenvironment shapes the homing and function of CD4+ T-cell populations

OBJECTIVE: Tissue-resident memory T cells (T(RM)) are vital immune sentinels that provide protective immunity. While hepatic CD8(+) T(RM) have been well described, little is known about the location, phenotype and function of CD4(+) T(RM). DESIGN: We used multiparametric flow cytometry, histological assessment and novel human tissue coculture systems to interrogate the ex vivo phenotype, function and generation of the intrahepatic CD4(+) T-cell compartment. We also used leukocytes isolated from human leukocyte antigen (HLA)-disparate liver allografts to assess long-term retention. RESULTS: Hepatic CD4(+) T cells were delineated into three distinct populations based on CD69 expression: CD69(−), CD69(INT) and CD69(HI). CD69(HI)CD4(+) cells were identified as tissue-resident CD4(+) T cells on the basis of their exclusion from the circulation, phenotypical profile (CXCR6(+)CD49a(+)S1PR1(−)PD-1(+)) and long-term persistence within the pool of donor-derived leukcoocytes in HLA-disparate liver allografts. CD69(HI)CD4(+) T cells produced robust type 1 polyfunctional cytokine responses on stimulation. Conversely, CD69(INT)CD4(+) T cells represented a more heterogenous population containing cells with a more activated phenotype, a distinct chemokine receptor profile (CX(3)CR1(+)CXCR3(+)CXCR1(+)) and a bias towards interleukin-4 production. While CD69(INT)CD4(+) T cells could be found in the circulation and lymph nodes, these cells also formed part of the long-term resident pool, persisting in HLA-mismatched allografts. Notably, frequencies of CD69(INT)CD4(+) T cells correlated with necroinflammatory scores in chronic hepatitis B infection. Finally, we demonstrated that interaction with hepatic epithelia was sufficient to generate CD69(INT)CD4(+) T cells, while additional signals from the liver microenvironment were required to generate liver-resident CD69(HI)CD4(+) T cells. CONCLUSIONS: High and intermediate CD69 expressions mark human hepatic CD4(+) T(RM) and a novel functionally distinct recirculating population, respectively, both shaped by the liver microenvironment to achieve diverse immunosurveillance