Ciara Wright

Background: Mucosal-associated invariant T (MAIT) cells promote inflammation in obesity and are implicated in the progression of non-alcoholic fatty liver disease (NAFLD). However, as the intrahepatic MAIT cell response to lifestyle intervention in NAFLD has not been investigated, this work aimed to examine circulating and intrahepatic MAIT cell populations in patients with NAFLD, after either 12 weeks of dietary intervention (DI) or aerobic exercise intervention (EI). Methods: Multicolour flow cytometry was used to immunophenotype circulating and intrahepatic MAIT cells and measure MAIT cell expression (median fluorescence intensity, MFI) of the activation marker CD69 and apoptotic marker CD95. Liver histology, clinical parameters, and MAIT cell populations were assessed at baseline (T0) and following completion (T1) of DI or EI. Results: Forty-five patients completed the study. DI participants showed decreased median (interquartile range) expression of the activation marker CD69 on circulating MAIT cells (T0: 104 (134) versus T1 27 (114) MFI; p = 0.0353) and improvements in histological steatosis grade post-intervention. EI participants showed increased expression of the apoptotic marker CD95, both in circulating (T0: 1549 (888) versus T1: 2563 (1371) MFI; p = 0.0043) and intrahepatic MAIT cells (T0: 2724 (862) versus T1: 3117 (1622) MFI; p = 0.0269). Moreover, the percentage of intrahepatic MAIT cells significantly decreased after EI (T0: 11.1 (14.4) versus T1: 5.3 (9.3)%; p = 0.0029), in conjunction with significant improvements in fibrosis stage and hepatocyte ballooning. Conclusions: These data demonstrate independent benefits from dietary and exercise intervention and suggest a role for intrahepatic MAIT cells in the observed histological improvements in NAFLD.

Small intestinal bacterial overgrowth (SIBO) is a common pathology in irritable bowel syndrome (IBS). Symptoms include bloating, excessive belching, flatulence, epigastric and abdominal pain, nausea, early satiety, fatigue and altered bowel habits. Given the high incidence of IBS globally, SIBO needs to be investigated in IBS using hydrogen and methane breath testing. Adherence to the North American Consensus 2017 or the updated guidelines from the Association of Gastrointestinal Physiology (AGIP) committee of the British Society of Gastroenterology 2019 is necessary to ensure that testing and diagnosis are standardised. The treatment of SIBO with antibiotics, most commonly rifaximin, may restore gastrointestinal function and reduce the symptoms of IBS. A number of herbal and nutraceutical supplements are known to exert antimicrobial effects. There is increasing awareness amongst the public regarding these herbal and nutraceutical supplements, and there is an increased demand for their use. The present study describes the case of a patient with severe IBS symptoms, scoring in the extreme category on a quality of life questionnaire validated for IBS and functional digestive disorders. The patient tested positive for SIBO, which was then eradicated using a herbal formulation containing garlic, berberine, oregano, grapefruit seed extract and caprylic acid, while following a diet low in fermentable oligo‑, di‑, mono‑saccharides and polyols (FODMAP). The patient's quality of life assessment markedly improved following treatment and the remaining symptoms improved at the 3‑month follow‑up performed by verbal confirmation.

Pregnancy is a time where expectant mothers often focus on their diet to improve their own health and to preserve the future health of their children. There is much conflicting information in the public domain about the safety and/or efficacy of nutritional supplements during pregnancy. Despite this, the market for supplements is growing. This review discusses the roles of critical nutrients in pregnancy and the available evidence on the use of supplements to reduce risks and improve maternal and fetal outcomes. Recommendations are made for pregnant women, taking into account safety data and tolerable upper intakes set for pregnant women. It is important for dieticians, nutritionists, physicians, and other healthcare providers to be able to offer accurate and evidence-based advice on supplement use in pregnancy. Routine supplementation may not be necessary for all, but individuals at risk are identified.