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Taurin Amino Asidinin Obezite ve Yağ Doku Üzerindeki Etkileri

Year 2020, , 41 - 54, 30.04.2020
https://doi.org/10.21020/husbfd.604727

Abstract



Obezite, sıklığı gittikçe artan ve ciddi sağlık sorunlarına yol açan metabolik bir rahatsızlıktır. Vücutta sağlığı bozabilecek düzeyde yağ birikimi obezitede gözlenen temel sorundur. Yağ miktarındaki artışın yanı sıra yağ dokudan salgılanan sinyal molekülleri ve adipokin salınımında değişiklikler, enerji metabolizmasının regülasyonunda bozulmalar, lipid ve glikoz homeostazisi bozuklukları da obezitede gözlenmektedir. Kükürtlü bir amino asit olan taurinin obezite üzerindeki etkileri son yıllarda tartışma konusu olmuştur. Taurinin; obezite durumunda ortaya çıkan bu metabolik bozukluklar üzerindeki olumlu etkileri, sitolojik, histolojik ve biyokimyasal düzeyde yapılan çalışmalarla farklı mekanizmalar üzerinden gösterilmiştir. Ancak; son zamanlarda obezite tedavisinde araştırılan beyaz yağ doku kahverengileşmesi üzerinde taurinin etkinliği ise belirsizliğini korumakta olup bu konuda kapsamlı çalışmaların yapılmasına ihtiyaç duyulmaktadır. Bu derlemede, taurinin obezite ve yağ doku üzerinde hangi mekanizmalarla etki ettiği ele alınmıştır.

References

  • Abd Elwahab, A. H., Ramadan, B. K., Schaalan, M. F., & Tolba, A. M. (2017). A Novel Role of SIRT1/ FGF-21 in Taurine Protection Against Cafeteria Diet-Induced Steatohepatitis in Rats. Cell Physiol Biochem, 43(2), 644-659.
  • Batista, T. M., Ribeiro, R. A., da Silva, P. M. R., Camargo, R. L., Lollo, P. C. B., Boschero, A. C., ve diğerleri. (2013). Taurine supplementation improves liver glucose control in normal protein and malnourished mice fed a high-fat diet. Mol Nutr Food Res, 57(3), 423-434.
  • Berköz, M., & Yalın, S. (2008). Yağ Dokusunun İmmünolojik ve İnflamatuvar Fonksiyonları. Mersin Univ Sag Bil Derg, 1(1), 1-9.
  • Borck, P. C., Vettorazzi, J. F., Branco, R. C. S., Batista, T. M., Santos-Silva, J. C., Nakanishi, V. Y., ve diğerleri. (2018). Taurine supplementation induces long-term beneficial effects on glucose homeostasis in ob/ob mice. Amino Acids, 50(6), 765-774.
  • Camargo, R., Batista, T., Ribeiro, R., Velloso, L., Boschero, A., & Carneiro, E. (2013). Effects of taurine supplementation upon food intake and central insulin signaling in malnourished mice fed on a high-fat diet. İçinde A. El Idrıssi & W. L’Amoreaux (Eds.), Taurine 8 Volume 2: Nutrition and Metabolism, Protective Role, and Role in Reproduction, Development, and Differentiation (pp. 93-103). New York, NY: Springer.
  • Cao, P. J., Jin, Y. J., Li, M. E., Zhou, R., & Yang, M. Z. (2016). PGC-1α may associated with the anti-obesity effect of taurine on rats induced by arcuate nucleus lesion. Nutr Neurosci, 19(2), 86-93.
  • Cesur, G., & Gökçimen, A. (2012). Yağ Dokusunun İşlevsel Sırları. ADU Tip Fak Derg, 13(2), 47-53.
  • Chang, Y. Y., Chou, C. H., Chiu, C. H., Yang, K. T., Lin, Y. L., Weng, W. L., ve diğerleri. (2011). Preventive effects of taurine on development of hepatic steatosis induced by a high-fat/cholesterol dietary habit. J Agric Food Chem, 59(1), 450-457.
  • Chusyd, D. E., Wang, D., Huffman, D. M., & Nagy, T. R. (2016). Relationships between Rodent White Adipose Fat Pads and Human White Adipose Fat Depots. Front Nutr, 3, 10.
  • Cypess, A. M., Lehman, S., Williams, G., Tal, I., Rodman, D., Goldfine, A. B., ve diğerleri. (2009). Identification and importance of brown adipose tissue in adult humans. N Engl J Med, 360(15), 1509-1517.
  • Donadelli, M., Dando, I., Fiorini, C., & Palmieri, M. (2014). UCP2, a mitochondrial protein regulated at multiple levels. Cell Mol Life Sci, 71(7), 1171-1190.
  • Erden, Y., Tekin, S., Kırbağ, S., & Sandal, S. (2015). Mitochondrial Uncoupling Proteins in the Brain: Their Structure, Function and Physiological Roles [Beyindeki Mitokondriyal Eşleşme Bozucu Proteinler: Yapısı, İşlevi ve Fizyolojik Rolleri]. Med-Science, 4(2), 2289-2307.
  • Fukuda, N., Yoshitama, A., Sugita, S., Fujita, M., & Murakami, S. (2011). Dietary taurine reduces hepatic secretion of cholesteryl ester and enhances fatty acid oxidation in rats fed a high-cholesterol diet. J Nutr Sci Vitaminol (Tokyo), 57(2), 144-149.
  • Garcia-Ruiz, E., Reynes, B., Diaz-Rua, R., Ceresi, E., Oliver, P., & Palou, A. (2015). The intake of high-fat diets induces the acquisition of brown adipocyte gene expression features in white adipose tissue. Int J Obes (Lond), 39(11), 1619-1629.
  • Gürbüz, P., Yetiş, G., & Çelikcan, G. (2016). Obezite ve Yağ Dokusu. TC İnönü Üniversitesi Sağlık Hizmetleri Meslek Yüksekokulu Dergisi, 5(8).
  • Hall, K. D. (2017). A review of the carbohydrate-insulin model of obesity. Eur J Clin Nutr, 71(3), 323-326.
  • Kim, K. S., Jang, M. J., Fang, S., Yoon, S. G., Kim, I. Y., Seong, J. K., ve diğerleri. (2019). Anti-obesity effect of taurine through inhibition of adipogenesis in white fat tissue but not in brown fat tissue in a high-fat diet-induced obese mouse model. Amino Acids, 51(2), 245-254.
  • Lin, S., Hirai, S., Yamaguchi, Y., Goto, T., Takahashi, N., Tani, F., ve diğerleri. (2013). Taurine improves obesity-induced inflammatory responses and modulates the unbalanced phenotype of adipose tissue macrophages. Mol Nutr Food Res, 57(12), 2155-2165.
  • Lo, K. A., & Sun, L. (2013). Turning WAT into BAT: a review on regulators controlling the browning of white adipocytes. Biosci Rep, 33(5).
  • Marroquín, F., & Willoughby, D. (2015). Factors Regulating Uncoupling Protein-3 (UCP-3) Expression in Skeletal Muscle. J Nutr Health Food Eng, 3(1), 00101.
  • Murakami, S. (2015). Role of taurine in the pathogenesis of obesity. Mol Nutr Food Res, 59(7), 1353-1363.
  • Murakami, S. (2017). The physiological and pathophysiological roles of taurine in adipose tissue in relation to obesity. Life Sci, 186, 80-86.
  • Nedergaard, J., Bengtsson, T., & Cannon, B. (2007). Unexpected evidence for active brown adipose tissue in adult humans. Am J Physiol Endocrinol Metab, 293(2), E444-452.
  • Okla, M., Kim, J., Koehler, K., & Chung, S. (2017). Dietary Factors Promoting Brown and Beige Fat Development and Thermogenesis. Adv Nutr, 8(3), 473-483.
  • Qiang, L., Wang, L., Kon, N., Zhao, W., Lee, S., Zhang, Y., ve diğerleri. (2012). Brown remodeling of white adipose tissue by SirT1-dependent deacetylation of Ppargamma. Cell, 150(3), 620-632.
  • Reddy, N. L., Tan, B. K., Barber, T. M., & Randeva, H. S. (2014). Brown adipose tissue: endocrine determinants of function and therapeutic manipulation as a novel treatment strategy for obesity. BMC Obes, 1, 13.
  • Rosa, F. T., Freitas, E. C., Deminice, R., Jordão, A. A., & Marchini, J. S. (2014). Oxidative stress and inflammation in obesity after taurine supplementation: a double-blind, placebo-controlled study. Eur J Nutr, 53(3), 823-830.
  • Rousset, S., Alves-Guerra, M. C., Mozo, J., Miroux, B., Cassard-Doulcier, A. M., Bouillaud, F., ve diğerleri. (2004). The biology of mitochondrial uncoupling proteins. Diabetes, 53 Suppl 1, S130-135.
  • Sagara, M., Murakami, S., Mizushima, S., Liu, L., Mori, M., Ikeda, K., ve diğerleri. (2015). Taurine in 24-h Urine Samples Is Inversely Related to Cardiovascular Risks of Middle Aged Subjects in 50 Populations of the World. Adv Exp Med Biol, 803, 623-636.
  • Sampey, B. P., Vanhoose, A. M., Winfield, H. M., Freemerman, A. J., Muehlbauer, M. J., Fueger, P. T., ve diğerleri. (2011). Cafeteria diet is a robust model of human metabolic syndrome with liver and adipose inflammation: comparison to high-fat diet. Obesity (Silver Spring), 19(6), 1109-1117.
  • Sanchez-Gurmaches, J., Hung, C. M., & Guertin, D. A. (2016). Emerging Complexities in Adipocyte Origins and Identity. Trends Cell Biol, 26(5), 313-326.
  • Sattari, M., & Mashayekhi, S. (2015). Obesity and Taurine. Adv Obes Weight Manag Control, 2(4), 00022.
  • Sudhakar, M., Silambanan, S., & Ramakrishnan, R. (2018). Sirtuins in Adipose Tissue Metabolism. İçinde L. Szablewski (Ed.), Adipose Tissue (pp. 29-49). London, UK: IntechOpen.
  • Tapia, P., Fernández-Galilea, M., Robledo, F., Mardones, P., Galgani, J. E., & Cortés, V. A. (2018). Biology and pathological implications of brown adipose tissue: promises and caveats for the control of obesity and its associated complications. Biol Rev, 93(2), 1145-1164.
  • Thibault, L. (2013). Animal Models of Dietary-Induced Obesity. İçinde P. M. Conn (Ed.), Animal Models for the Study of Human Disease (1st ed., pp. 277-303). Oregon, USA: Academic Press (Elsevier).
  • Trayhurn, P. (2016). Recruiting Brown Adipose Tissue in Human Obesity. Diabetes, 65(5), 1158-1160.
  • Tsuboyama-Kasaoka, N., Shozawa, C., Sano, K., Kamei, Y., Kasaoka, S., Hosokawa, Y., ve diğerleri. (2006). Taurine (2-aminoethanesulfonic acid) deficiency creates a vicious circle promoting obesity. Endocrinology, 147(7), 3276-3284.
  • Varlamov, O. (2017). Western-style diet, sex steroids and metabolism. Biochim Biophys Acta.
  • Wen, C., Li, F., Zhang, L., Duan, Y., Guo, Q., Wang, W., ve diğerleri. (2018). Taurine is Involved in Energy Metabolism in Muscles, Adipose Tissue, and the Liver. Mol Nutr Food Res, e1800536.
  • WHO. (2017) Controlling the global obesity epidemic. https://www.who.int/nutrition/topics/obesity/en/ adresinden elde edildi
  • WHO. (2018) Obesity and overweight Fact sheet. http://www.who.int/mediacentre/factsheets/fs311/en/# adresinden elde edildi
  • You, J., Zhao, X., Kim, S., & Chang, K. (2013). Positive correlation between serum taurine and adiponectin levels in high-fat diet-induced obesity rats. İçinde A. El Idrıssi & W. L’Amoreaux (Eds.), Taurine 8 Volume 2: Nutrition and Metabolism, Protective Role, and Role in Reproduction, Development, and Differentiation (pp. 105-111). New York, NY: Springer.
  • Zafrir, B. (2013). Brown adipose tissue: research milestones of a potential player in human energy balance and obesity. Horm Metab Res, 45(11), 774-785.
  • Zhang, M., Bi, L. F., Fang, J. H., Su, X. L., Da, G. L., Kuwamori, T., ve diğerleri. (2004). Beneficial effects of taurine on serum lipids in overweight or obese non-diabetic subjects. Amino Acids, 26(3), 267-271.

Effects of Taurine Amino Acid on Obesity and Adipose Tissue

Year 2020, , 41 - 54, 30.04.2020
https://doi.org/10.21020/husbfd.604727

Abstract



Obesity is a metabolic disorder with increasing prevalence and serious health problems. Fat accumulation in the body that can disrupt health is the main problem observed in obesity. In addition to increase in the amount of fat, signal molecules secreted from adipose tissue and changes in adipokine release, disturbances in regulation of energy metabolism and lipid and glucose homeostasis disorders are also observed in obesity. The effects of taurine, a sulfuric amino acid, on obesity have been controversial in recent years. The positive effects of taurine on these metabolic disorders in the case of obesity have been demonstrated by different mechanisms by studies on cytological, histological and biochemical levels. However, the efficiency of taurine on white adipose tissue browning, which has recently been investigated in the treatment of obesity, remains unclear, and extensive studies are needed to be made on this topic. In this review, the mechanisms by which taurine acts on obesity and adipose tissue are discussed.

References

  • Abd Elwahab, A. H., Ramadan, B. K., Schaalan, M. F., & Tolba, A. M. (2017). A Novel Role of SIRT1/ FGF-21 in Taurine Protection Against Cafeteria Diet-Induced Steatohepatitis in Rats. Cell Physiol Biochem, 43(2), 644-659.
  • Batista, T. M., Ribeiro, R. A., da Silva, P. M. R., Camargo, R. L., Lollo, P. C. B., Boschero, A. C., ve diğerleri. (2013). Taurine supplementation improves liver glucose control in normal protein and malnourished mice fed a high-fat diet. Mol Nutr Food Res, 57(3), 423-434.
  • Berköz, M., & Yalın, S. (2008). Yağ Dokusunun İmmünolojik ve İnflamatuvar Fonksiyonları. Mersin Univ Sag Bil Derg, 1(1), 1-9.
  • Borck, P. C., Vettorazzi, J. F., Branco, R. C. S., Batista, T. M., Santos-Silva, J. C., Nakanishi, V. Y., ve diğerleri. (2018). Taurine supplementation induces long-term beneficial effects on glucose homeostasis in ob/ob mice. Amino Acids, 50(6), 765-774.
  • Camargo, R., Batista, T., Ribeiro, R., Velloso, L., Boschero, A., & Carneiro, E. (2013). Effects of taurine supplementation upon food intake and central insulin signaling in malnourished mice fed on a high-fat diet. İçinde A. El Idrıssi & W. L’Amoreaux (Eds.), Taurine 8 Volume 2: Nutrition and Metabolism, Protective Role, and Role in Reproduction, Development, and Differentiation (pp. 93-103). New York, NY: Springer.
  • Cao, P. J., Jin, Y. J., Li, M. E., Zhou, R., & Yang, M. Z. (2016). PGC-1α may associated with the anti-obesity effect of taurine on rats induced by arcuate nucleus lesion. Nutr Neurosci, 19(2), 86-93.
  • Cesur, G., & Gökçimen, A. (2012). Yağ Dokusunun İşlevsel Sırları. ADU Tip Fak Derg, 13(2), 47-53.
  • Chang, Y. Y., Chou, C. H., Chiu, C. H., Yang, K. T., Lin, Y. L., Weng, W. L., ve diğerleri. (2011). Preventive effects of taurine on development of hepatic steatosis induced by a high-fat/cholesterol dietary habit. J Agric Food Chem, 59(1), 450-457.
  • Chusyd, D. E., Wang, D., Huffman, D. M., & Nagy, T. R. (2016). Relationships between Rodent White Adipose Fat Pads and Human White Adipose Fat Depots. Front Nutr, 3, 10.
  • Cypess, A. M., Lehman, S., Williams, G., Tal, I., Rodman, D., Goldfine, A. B., ve diğerleri. (2009). Identification and importance of brown adipose tissue in adult humans. N Engl J Med, 360(15), 1509-1517.
  • Donadelli, M., Dando, I., Fiorini, C., & Palmieri, M. (2014). UCP2, a mitochondrial protein regulated at multiple levels. Cell Mol Life Sci, 71(7), 1171-1190.
  • Erden, Y., Tekin, S., Kırbağ, S., & Sandal, S. (2015). Mitochondrial Uncoupling Proteins in the Brain: Their Structure, Function and Physiological Roles [Beyindeki Mitokondriyal Eşleşme Bozucu Proteinler: Yapısı, İşlevi ve Fizyolojik Rolleri]. Med-Science, 4(2), 2289-2307.
  • Fukuda, N., Yoshitama, A., Sugita, S., Fujita, M., & Murakami, S. (2011). Dietary taurine reduces hepatic secretion of cholesteryl ester and enhances fatty acid oxidation in rats fed a high-cholesterol diet. J Nutr Sci Vitaminol (Tokyo), 57(2), 144-149.
  • Garcia-Ruiz, E., Reynes, B., Diaz-Rua, R., Ceresi, E., Oliver, P., & Palou, A. (2015). The intake of high-fat diets induces the acquisition of brown adipocyte gene expression features in white adipose tissue. Int J Obes (Lond), 39(11), 1619-1629.
  • Gürbüz, P., Yetiş, G., & Çelikcan, G. (2016). Obezite ve Yağ Dokusu. TC İnönü Üniversitesi Sağlık Hizmetleri Meslek Yüksekokulu Dergisi, 5(8).
  • Hall, K. D. (2017). A review of the carbohydrate-insulin model of obesity. Eur J Clin Nutr, 71(3), 323-326.
  • Kim, K. S., Jang, M. J., Fang, S., Yoon, S. G., Kim, I. Y., Seong, J. K., ve diğerleri. (2019). Anti-obesity effect of taurine through inhibition of adipogenesis in white fat tissue but not in brown fat tissue in a high-fat diet-induced obese mouse model. Amino Acids, 51(2), 245-254.
  • Lin, S., Hirai, S., Yamaguchi, Y., Goto, T., Takahashi, N., Tani, F., ve diğerleri. (2013). Taurine improves obesity-induced inflammatory responses and modulates the unbalanced phenotype of adipose tissue macrophages. Mol Nutr Food Res, 57(12), 2155-2165.
  • Lo, K. A., & Sun, L. (2013). Turning WAT into BAT: a review on regulators controlling the browning of white adipocytes. Biosci Rep, 33(5).
  • Marroquín, F., & Willoughby, D. (2015). Factors Regulating Uncoupling Protein-3 (UCP-3) Expression in Skeletal Muscle. J Nutr Health Food Eng, 3(1), 00101.
  • Murakami, S. (2015). Role of taurine in the pathogenesis of obesity. Mol Nutr Food Res, 59(7), 1353-1363.
  • Murakami, S. (2017). The physiological and pathophysiological roles of taurine in adipose tissue in relation to obesity. Life Sci, 186, 80-86.
  • Nedergaard, J., Bengtsson, T., & Cannon, B. (2007). Unexpected evidence for active brown adipose tissue in adult humans. Am J Physiol Endocrinol Metab, 293(2), E444-452.
  • Okla, M., Kim, J., Koehler, K., & Chung, S. (2017). Dietary Factors Promoting Brown and Beige Fat Development and Thermogenesis. Adv Nutr, 8(3), 473-483.
  • Qiang, L., Wang, L., Kon, N., Zhao, W., Lee, S., Zhang, Y., ve diğerleri. (2012). Brown remodeling of white adipose tissue by SirT1-dependent deacetylation of Ppargamma. Cell, 150(3), 620-632.
  • Reddy, N. L., Tan, B. K., Barber, T. M., & Randeva, H. S. (2014). Brown adipose tissue: endocrine determinants of function and therapeutic manipulation as a novel treatment strategy for obesity. BMC Obes, 1, 13.
  • Rosa, F. T., Freitas, E. C., Deminice, R., Jordão, A. A., & Marchini, J. S. (2014). Oxidative stress and inflammation in obesity after taurine supplementation: a double-blind, placebo-controlled study. Eur J Nutr, 53(3), 823-830.
  • Rousset, S., Alves-Guerra, M. C., Mozo, J., Miroux, B., Cassard-Doulcier, A. M., Bouillaud, F., ve diğerleri. (2004). The biology of mitochondrial uncoupling proteins. Diabetes, 53 Suppl 1, S130-135.
  • Sagara, M., Murakami, S., Mizushima, S., Liu, L., Mori, M., Ikeda, K., ve diğerleri. (2015). Taurine in 24-h Urine Samples Is Inversely Related to Cardiovascular Risks of Middle Aged Subjects in 50 Populations of the World. Adv Exp Med Biol, 803, 623-636.
  • Sampey, B. P., Vanhoose, A. M., Winfield, H. M., Freemerman, A. J., Muehlbauer, M. J., Fueger, P. T., ve diğerleri. (2011). Cafeteria diet is a robust model of human metabolic syndrome with liver and adipose inflammation: comparison to high-fat diet. Obesity (Silver Spring), 19(6), 1109-1117.
  • Sanchez-Gurmaches, J., Hung, C. M., & Guertin, D. A. (2016). Emerging Complexities in Adipocyte Origins and Identity. Trends Cell Biol, 26(5), 313-326.
  • Sattari, M., & Mashayekhi, S. (2015). Obesity and Taurine. Adv Obes Weight Manag Control, 2(4), 00022.
  • Sudhakar, M., Silambanan, S., & Ramakrishnan, R. (2018). Sirtuins in Adipose Tissue Metabolism. İçinde L. Szablewski (Ed.), Adipose Tissue (pp. 29-49). London, UK: IntechOpen.
  • Tapia, P., Fernández-Galilea, M., Robledo, F., Mardones, P., Galgani, J. E., & Cortés, V. A. (2018). Biology and pathological implications of brown adipose tissue: promises and caveats for the control of obesity and its associated complications. Biol Rev, 93(2), 1145-1164.
  • Thibault, L. (2013). Animal Models of Dietary-Induced Obesity. İçinde P. M. Conn (Ed.), Animal Models for the Study of Human Disease (1st ed., pp. 277-303). Oregon, USA: Academic Press (Elsevier).
  • Trayhurn, P. (2016). Recruiting Brown Adipose Tissue in Human Obesity. Diabetes, 65(5), 1158-1160.
  • Tsuboyama-Kasaoka, N., Shozawa, C., Sano, K., Kamei, Y., Kasaoka, S., Hosokawa, Y., ve diğerleri. (2006). Taurine (2-aminoethanesulfonic acid) deficiency creates a vicious circle promoting obesity. Endocrinology, 147(7), 3276-3284.
  • Varlamov, O. (2017). Western-style diet, sex steroids and metabolism. Biochim Biophys Acta.
  • Wen, C., Li, F., Zhang, L., Duan, Y., Guo, Q., Wang, W., ve diğerleri. (2018). Taurine is Involved in Energy Metabolism in Muscles, Adipose Tissue, and the Liver. Mol Nutr Food Res, e1800536.
  • WHO. (2017) Controlling the global obesity epidemic. https://www.who.int/nutrition/topics/obesity/en/ adresinden elde edildi
  • WHO. (2018) Obesity and overweight Fact sheet. http://www.who.int/mediacentre/factsheets/fs311/en/# adresinden elde edildi
  • You, J., Zhao, X., Kim, S., & Chang, K. (2013). Positive correlation between serum taurine and adiponectin levels in high-fat diet-induced obesity rats. İçinde A. El Idrıssi & W. L’Amoreaux (Eds.), Taurine 8 Volume 2: Nutrition and Metabolism, Protective Role, and Role in Reproduction, Development, and Differentiation (pp. 105-111). New York, NY: Springer.
  • Zafrir, B. (2013). Brown adipose tissue: research milestones of a potential player in human energy balance and obesity. Horm Metab Res, 45(11), 774-785.
  • Zhang, M., Bi, L. F., Fang, J. H., Su, X. L., Da, G. L., Kuwamori, T., ve diğerleri. (2004). Beneficial effects of taurine on serum lipids in overweight or obese non-diabetic subjects. Amino Acids, 26(3), 267-271.
There are 44 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

Yücel Büyükdere 0000-0003-2366-8735

Aslı Akyol Mutlu 0000-0001-6301-6358

Publication Date April 30, 2020
Submission Date August 9, 2019
Published in Issue Year 2020

Cite

APA Büyükdere, Y., & Akyol Mutlu, A. (2020). Taurin Amino Asidinin Obezite ve Yağ Doku Üzerindeki Etkileri. Hacettepe University Faculty of Health Sciences Journal, 7(1), 41-54. https://doi.org/10.21020/husbfd.604727