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Palm Yağı ve Sağlık Üzerine Etkileri

Yıl 2018, , 54 - 58, 06.12.2018
https://doi.org/10.22312/sdusbed.381511

Öz

Palm yağı, Elaeis Guineensis isimli palm ağacının meyvesinden elde edilen bitkisel bir yağdır. Besin endüstrisinde düşük maliyetli olması nedeniyle sıklıkla tercih edilmektedir. Başta Malezya ve Endonezya olmak üzere birçok ülkede üretilen palm yağının sağlık üzerine etkileri merak konusu olmuştur. Çünkü yüksek oranda E vitamini ve karotenoid gibi antioksidan içeren palm yağının kardiyovasküler hastalıklar, diyabet ve kanser üzerine olumlu etkilerinin yanı sıra, doymuş yağ içeriğine ve yüksek sıcaklıktaki rafinasyon işlemi sonrası oluşan kloropropanollere bağlı olarak olumsuz etkilerinin olduğunu gösteren çelişkili veriler bulunmaktadır. Ancak yapılan çalışmalar, yüksek sıcaklığa maruz kalan diğer bitkisel yağların da olumsuz etkilerinin olduğunu göstermektedir. Yakın zamanda palm yağının diğer bitkisel yağlara kıyasla daha zararlı olduğu ile ilgili görüşler ortaya atılmıştır. Bu nedenle palm yağının sağlık üzerine etkileri kanıta dayalı veriler ışığında tartışılacaktır.

Kaynakça

  • 1. UNDP [Internet]. Palm Oil Scoping Paper 2010 [Cited: 2017 Sep 09]. Available from: http://www.undp.org/content/dam/undp/library/Environment%20and%20Energy/Green%20Commodities%20Facility/Palm.oil.scoping.paper.pdf
  • 2. Sambanthamurthi R, Sundram K, Tan YA. Chemistry and biochemistry of palm oil. Prog Lipid Res 2000; 39(6): 507-58.
  • 3. FAO [Internet]. Analysis of incentives and disincentives for palm oil in Nigeria 2013 [Cited: 2017 Sep 11]. Available from: http://www.fao.org/3/a-at585e.pdf
  • 4. Singh R, Ong-Abdullah M, Low ETL, Manaf MAA, Rosli R, Nookiah R, et al. Oil palm genome sequence reveals divergence of interfertile species in Old and New worlds. Nature 2013; 500(7462): 340-44.
  • 5. O’Brien RD. Fats and Oils: Formulating and Processing for Applications. 2nd ed. Florida, CRC Press, 2010; p. 53-60.
  • 6. Gold IL, Ukhun ME, Akoh CC. Characteristics of eutectic compositions of eestructured palm oil olein, palm kernel oil and their mixtures. J Am Oil Chem Soc 2011; 88: 1659–67.
  • 7. Clitfon PM. Palm oil and LDL cholesterol. Am J Clin Nutr 2011; 94: 1392–3.
  • 8. May CY, Nesaretnam K. Research advancements in palm oil nutrition. Eur J Lipid Sci Technol 2014; 116: 1301–15.
  • 9. Atinmo T, Bakre AT. Palm fruit in traditional African food culture. Asia Pac J Clin Nutr 2003; 12(3): 350-4.
  • 10. Ramirez M, Amate L, Gil A. Absorption and distribution of dietary fatty acids from different sources. Early Hum Dev 2001; 65: 95-101.
  • 11. Han NM, May CY. Determination of antioxidants in oil palm leaves (Elaeis guineensis). Am J Appl Sci 2010; 7(9): 1243-47.
  • 12. Othman N, Manan ZA, Wanalvi SR, Sarmidi MR. A review of extraction technology for carotenoids and vitamin E recovery from palm oil. J Applied Sci 2010; 10(12): 1187-91.
  • 13. Mba OI, Dumont MJ, Ngadi M. Palm oil: Processing, characterization and utilization in the food industry – A review. Food Biosci 2015; 10: 26-41.
  • 14. Hamid AA, Dek MS, Tan CP, Zainudin MA, Fang EK. Changes of major antioxidant compounds and radical scavenging activity of palm oil and rice bran oil during deep-frying. Antioxidants 2014; 3(3): 502-15.
  • 15. Sundram K, Sambanthamurthi R, Tan YA. Palm fruit chemistry and nutrition. Asia Pac J Clin Nutr 2003; 12(3): 355-62.
  • 16. Doerner SK, Berger NA. Dietary fats as mediators of obesity, inflammation, and colon cancer. In: Dannenberg A, Berger N, editors. Obesity, Inflammation and Cancer. Energy Balance and Cancer. Vol 7. New York, Springer, 2013; p. 99-132.
  • 17. Edem DO. Palm oil: Biochemical, physiological, nutritional, hematological and toxicological aspects: A review. Plant Foods Hum Nutr 2002; 57(3-4): 319-41.
  • 18. Ong AS, Goh SH. Palm Oil: A healthful and cost-effective dietary component. Food Nutr Bull 2002; 23(1): 11-22.
  • 19. Sen CK, Khanna S, Roy S. Tocotrienols in health and disease: the other half of the natural vitamin E family. Mol Aspects Med 2007; 28(5): 692-728.
  • 20. Onyeali EU, Onwuchekwa AC, Monago CC, Monanu MO. Plasma lipid profile of Wistar albino rats fed palm oil-supplemented diets. Int. J. Biol. Chem. Sci 2010; 4(4): 1163-69.
  • 21. Oluba OM, Onyeneke CE, Ojieh GC, Eidangbe GO, Orole RT. Effects of palm oil supplementation on lipid peroxidation and glutathione peroxidase activity in cholesterol fed rats. Int J Cardiovasc Res 2009; 6(1): 1-6.
  • 22. Truswell AS. Comparing palmolein with different predominantly monounsaturated oils: effect on plasma lipids. Int J Food Sci Nutr 2000; 51(1): 73-7.
  • 23. Adam SK, Soelaiman IN, Umar NA, Mokhtar N, Mohamed N, Jaarin K. Effects of repeatedly heated palm oil on serum lipid profile, lipid peroxidation and homocysteine levels in a post-menopausal rat model. Mcgill J Med 2008, 11(2): 145-51.
  • 24. Xian TK, Omar NA, Ying LW, Hamzah A, Raj S, Jaarin K, et al. Reheated palm oil consumption and risk of atherosclerosis: evidence at ultrastructural level. J Evid Based Complementary Altern Med 2012; 2012: 1-6.
  • 25. Kamsiah J, Aziz SN, Siew ST, Zahir IS. Changes in serum lipid profile and malondialdehyde following consumption of fresh or heated red palm oil. Med J Islamic World Acad Sci 2001; 14(2): 79-86.
  • 26. Adam SK, Das S, Soelaiman IN, Umar NA, Jaarin K. Consumption of repeatedly heated soy oil increases the serum parameters related to atherosclerosis in ovariectomized rats. Tohoku J Exp Med 2008; 215(3): 219-26.
  • 27. Quiles JL, Huertas JR, Battino M, Ramírez-Tortosa MC, Cassinello M, Mataix J, et al. The intake of fried virgin olive or sunflower oils differentially induces oxidative stress in rat liver microsomes. Br J Nutr 2002; 88(1): 57-65.
  • 28. Ikemoto S, Takahashi M, Tsunoda N, Maruyama K, Itakura H, Ezaki O. High-fat diet-induced hyperglycemia and obesity in mice: differential effects of dietary oils. Metabolism 1996; 45(12): 1539-46.
  • 29. Ngueguim FT, Esse EC, Dzeufiet PD, Gounoue RK, Bilanda DC1, Kamtchouing P, et al. Oxidised palm oil and sucrose induced hyperglycemia in normal rats: effects of Sclerocarya birrea stem barks aqueous extract. BMC Complement Altern Med 2016; 16(1): 47-57.
  • 30. Li X, Yu X, Sun D, Li J, Wang Y, Cao P, et al. Effects of polar compounds generated from deep-frying process of palm oil on lipid metabolism and glucose tolerance in Kunming mice. J Agric Food Chem 2017; 65(1): 208-15.
  • 31. Kochikuzhyil BM, Devi K, Fattepur SR. Effect of saturated fatty acid-rich dietary vegetable oils on lipid profile, antioxidant enzymes and glucose tolerance in diabetic rats. Indian J. Pharmacol 2010; 42: 142-5.
  • 32. Van Amelsvoort JMM, Van der Beek A, Stam JJ. Effects of the type of dietary fatty acid on the insulin receptor function in rat epididymal fat cells. Ann Nutr Metab 1986; 30: 273-80.
  • 33. Adewale OF, Isaac O, Tunmise MT, Omoniyi O. Palm oil and ground nut oil supplementation effects on blood glucose and antioxidant status in alloxan-induced diabetic rats. Pak J Pharm Sci 2016; 29(1): 83-7.
  • 34. Budin SB, Idris MH, Hamid ZA, Mohamed J. Tocotrienol-rich fraction of palm oil reduced pancreatic damage and oxidative stress in streptozotocin-induced diabetic rats. Aust J Basic Appl Sci 2011; 5(12): 2367-74.
  • 35. Sundram K, Karupaiah T, Hayes KC. Stearic acid-rich interesterified fat and trans-rich fat raise the LDL/HDL ratio and plasma glucose relative to palm olein in humans. Nutr Metab (Lond) 2007; 4(1): 3-14.
  • 36. Rosqvist F, Iggman D, Kullberg J, Cedernaes J, Johansson HE, Larsson A, et al. Overfeeding polyunsaturated and saturated fat causes distinct effects on liver and visceral fat accumulation in humans. Diabetes 2014; 63: 2356-68.
  • 37. Takeuti TD, Terra GA, da Silva AA, Terra JA Jr, da Silva LM, Crema E. Effect of the ingestion of the palm oil and glutamine in serum levels of GLP-1, PYY and glycemia in diabetes mellitus type 2 patients submitted to metabolic surgery. Arq Bras Cir Dig 2014; 27(1): 51-5.
  • 38. Kumar KS, Raghavan M, Hieber K, Ege C, Mog S, Parra N, et al. Preferential radiation sensitization of prostate cancer in nude mice by nutraceutical antioxidant gamma-tocotrienol. Life Sci 2009; 78: 2099-104.
  • 39. Komarasamy TV, Sekaran SD. The anti-proliferative effects of a palm oil-derived product and its mode of actions in human malignant melanoma MeWo cells. J Oleo Sci 2012; 61: 227-39.
  • 40. Balasundram N, Tan YA, Sambanthamurthi R, Sundram K, Samman S. Antioxidant properties of palm fruit extracts. Asia Pac J Clin Nutr 2005; 14: 319-24.
  • 41. Ji X, Usman A, Razalli NH, Sambanthamurthi R, Gupta SV. Oil palm phenolics (OPP) inhibit pancreatic cancer cell proliferation via suppression of NF-κB pathway. Anticancer Res 2015; 35(1): 97-106.
  • 42. Lim SW, Loh HS, Ting KN, Bradshaw TD, Zeenathul NA. Antiproliferation and induction of caspase-8-dependent mitochondria-mediated apoptosis by b-tocotrienol in human lung and brain cancer cell lines. Biomed Pharmacother 2014; 68: 1105–15.
  • 43. Tran AT, Ramalinga M, Kedir H, Clarke R, Kumar D. Autophagy inhibitor 3-methyladenine potentiates apoptosis induced by dietary tocotrienols in breast cancer cells. Eur J Nutr 2015; 54(2): 265–72.
  • 44. Sczaniecka AK, Brasky TM, Lampe JW, Patterson RE, White E. Dietary intake of specific fatty acids and breast cancer risk among postmenopausal women in the VITAL cohort. Nutr Cancer 2012; 64: 1131–42.
  • 45. EFSA [Internet]. Risks for human health related to the presence of 3- and 2-monochloropropanediol (MCPD), and their fatty acid esters, and glycidyl fatty acid esters in food 2016 [Cited: 2017 Oct 10]. Available from: https://www.efsa.europa.eu/en/efsajournal/pub/4426
  • 46. Cheng WW, Liu GQ, Wang LQ, Liu ZS. Glycidyl fatty acid esters in refined edible oils: A review on formation, occurrence, analysis, and elimination methods. Compr Rev Food Sci Food Saf 2017; 16(2): 263-81.
  • 47. Matthäus B. Use of palm oil for frying in comparison with other high‐stability oils. Eur J Lipid Sci Technol 2007; 109(4): 400-9.
  • 48. Nantha HS, Tisdell C. The orangutan–oil palm conflict: Economic constraints and opportunities for conservation. Biodivers Conserv 2009; 18(2): 487-502.

PALM OIL AND EFFECTS ON HEALTH

Yıl 2018, , 54 - 58, 06.12.2018
https://doi.org/10.22312/sdusbed.381511

Öz

Palm oil is a vegetable oil obtained from fruit of palm tree named Elaeis Guineensis. Palm oil is often preferred due to low cost in food industry. The health effects of palm oil produced in many countries, especially in Malaysia and Indonesia, is a matter of curiosity. Because there is conflicting evidence that palm oil containing high levels of antioxidants such as vitamin E and carotenoid has positive effects on cardiovascular diseases, diabetes and cancer as well as negative effects due to saturated fat content and chloropropanols formed after refining at high temperature. However, studies have shown that other vegetable oils exposed to high temperatures also have negative effects. There are opinions that palm oil is more harmful than other vegetable oils recently. For this reason, the health effects of palm oil will be discussed in the light of the evidence-based data. 

Kaynakça

  • 1. UNDP [Internet]. Palm Oil Scoping Paper 2010 [Cited: 2017 Sep 09]. Available from: http://www.undp.org/content/dam/undp/library/Environment%20and%20Energy/Green%20Commodities%20Facility/Palm.oil.scoping.paper.pdf
  • 2. Sambanthamurthi R, Sundram K, Tan YA. Chemistry and biochemistry of palm oil. Prog Lipid Res 2000; 39(6): 507-58.
  • 3. FAO [Internet]. Analysis of incentives and disincentives for palm oil in Nigeria 2013 [Cited: 2017 Sep 11]. Available from: http://www.fao.org/3/a-at585e.pdf
  • 4. Singh R, Ong-Abdullah M, Low ETL, Manaf MAA, Rosli R, Nookiah R, et al. Oil palm genome sequence reveals divergence of interfertile species in Old and New worlds. Nature 2013; 500(7462): 340-44.
  • 5. O’Brien RD. Fats and Oils: Formulating and Processing for Applications. 2nd ed. Florida, CRC Press, 2010; p. 53-60.
  • 6. Gold IL, Ukhun ME, Akoh CC. Characteristics of eutectic compositions of eestructured palm oil olein, palm kernel oil and their mixtures. J Am Oil Chem Soc 2011; 88: 1659–67.
  • 7. Clitfon PM. Palm oil and LDL cholesterol. Am J Clin Nutr 2011; 94: 1392–3.
  • 8. May CY, Nesaretnam K. Research advancements in palm oil nutrition. Eur J Lipid Sci Technol 2014; 116: 1301–15.
  • 9. Atinmo T, Bakre AT. Palm fruit in traditional African food culture. Asia Pac J Clin Nutr 2003; 12(3): 350-4.
  • 10. Ramirez M, Amate L, Gil A. Absorption and distribution of dietary fatty acids from different sources. Early Hum Dev 2001; 65: 95-101.
  • 11. Han NM, May CY. Determination of antioxidants in oil palm leaves (Elaeis guineensis). Am J Appl Sci 2010; 7(9): 1243-47.
  • 12. Othman N, Manan ZA, Wanalvi SR, Sarmidi MR. A review of extraction technology for carotenoids and vitamin E recovery from palm oil. J Applied Sci 2010; 10(12): 1187-91.
  • 13. Mba OI, Dumont MJ, Ngadi M. Palm oil: Processing, characterization and utilization in the food industry – A review. Food Biosci 2015; 10: 26-41.
  • 14. Hamid AA, Dek MS, Tan CP, Zainudin MA, Fang EK. Changes of major antioxidant compounds and radical scavenging activity of palm oil and rice bran oil during deep-frying. Antioxidants 2014; 3(3): 502-15.
  • 15. Sundram K, Sambanthamurthi R, Tan YA. Palm fruit chemistry and nutrition. Asia Pac J Clin Nutr 2003; 12(3): 355-62.
  • 16. Doerner SK, Berger NA. Dietary fats as mediators of obesity, inflammation, and colon cancer. In: Dannenberg A, Berger N, editors. Obesity, Inflammation and Cancer. Energy Balance and Cancer. Vol 7. New York, Springer, 2013; p. 99-132.
  • 17. Edem DO. Palm oil: Biochemical, physiological, nutritional, hematological and toxicological aspects: A review. Plant Foods Hum Nutr 2002; 57(3-4): 319-41.
  • 18. Ong AS, Goh SH. Palm Oil: A healthful and cost-effective dietary component. Food Nutr Bull 2002; 23(1): 11-22.
  • 19. Sen CK, Khanna S, Roy S. Tocotrienols in health and disease: the other half of the natural vitamin E family. Mol Aspects Med 2007; 28(5): 692-728.
  • 20. Onyeali EU, Onwuchekwa AC, Monago CC, Monanu MO. Plasma lipid profile of Wistar albino rats fed palm oil-supplemented diets. Int. J. Biol. Chem. Sci 2010; 4(4): 1163-69.
  • 21. Oluba OM, Onyeneke CE, Ojieh GC, Eidangbe GO, Orole RT. Effects of palm oil supplementation on lipid peroxidation and glutathione peroxidase activity in cholesterol fed rats. Int J Cardiovasc Res 2009; 6(1): 1-6.
  • 22. Truswell AS. Comparing palmolein with different predominantly monounsaturated oils: effect on plasma lipids. Int J Food Sci Nutr 2000; 51(1): 73-7.
  • 23. Adam SK, Soelaiman IN, Umar NA, Mokhtar N, Mohamed N, Jaarin K. Effects of repeatedly heated palm oil on serum lipid profile, lipid peroxidation and homocysteine levels in a post-menopausal rat model. Mcgill J Med 2008, 11(2): 145-51.
  • 24. Xian TK, Omar NA, Ying LW, Hamzah A, Raj S, Jaarin K, et al. Reheated palm oil consumption and risk of atherosclerosis: evidence at ultrastructural level. J Evid Based Complementary Altern Med 2012; 2012: 1-6.
  • 25. Kamsiah J, Aziz SN, Siew ST, Zahir IS. Changes in serum lipid profile and malondialdehyde following consumption of fresh or heated red palm oil. Med J Islamic World Acad Sci 2001; 14(2): 79-86.
  • 26. Adam SK, Das S, Soelaiman IN, Umar NA, Jaarin K. Consumption of repeatedly heated soy oil increases the serum parameters related to atherosclerosis in ovariectomized rats. Tohoku J Exp Med 2008; 215(3): 219-26.
  • 27. Quiles JL, Huertas JR, Battino M, Ramírez-Tortosa MC, Cassinello M, Mataix J, et al. The intake of fried virgin olive or sunflower oils differentially induces oxidative stress in rat liver microsomes. Br J Nutr 2002; 88(1): 57-65.
  • 28. Ikemoto S, Takahashi M, Tsunoda N, Maruyama K, Itakura H, Ezaki O. High-fat diet-induced hyperglycemia and obesity in mice: differential effects of dietary oils. Metabolism 1996; 45(12): 1539-46.
  • 29. Ngueguim FT, Esse EC, Dzeufiet PD, Gounoue RK, Bilanda DC1, Kamtchouing P, et al. Oxidised palm oil and sucrose induced hyperglycemia in normal rats: effects of Sclerocarya birrea stem barks aqueous extract. BMC Complement Altern Med 2016; 16(1): 47-57.
  • 30. Li X, Yu X, Sun D, Li J, Wang Y, Cao P, et al. Effects of polar compounds generated from deep-frying process of palm oil on lipid metabolism and glucose tolerance in Kunming mice. J Agric Food Chem 2017; 65(1): 208-15.
  • 31. Kochikuzhyil BM, Devi K, Fattepur SR. Effect of saturated fatty acid-rich dietary vegetable oils on lipid profile, antioxidant enzymes and glucose tolerance in diabetic rats. Indian J. Pharmacol 2010; 42: 142-5.
  • 32. Van Amelsvoort JMM, Van der Beek A, Stam JJ. Effects of the type of dietary fatty acid on the insulin receptor function in rat epididymal fat cells. Ann Nutr Metab 1986; 30: 273-80.
  • 33. Adewale OF, Isaac O, Tunmise MT, Omoniyi O. Palm oil and ground nut oil supplementation effects on blood glucose and antioxidant status in alloxan-induced diabetic rats. Pak J Pharm Sci 2016; 29(1): 83-7.
  • 34. Budin SB, Idris MH, Hamid ZA, Mohamed J. Tocotrienol-rich fraction of palm oil reduced pancreatic damage and oxidative stress in streptozotocin-induced diabetic rats. Aust J Basic Appl Sci 2011; 5(12): 2367-74.
  • 35. Sundram K, Karupaiah T, Hayes KC. Stearic acid-rich interesterified fat and trans-rich fat raise the LDL/HDL ratio and plasma glucose relative to palm olein in humans. Nutr Metab (Lond) 2007; 4(1): 3-14.
  • 36. Rosqvist F, Iggman D, Kullberg J, Cedernaes J, Johansson HE, Larsson A, et al. Overfeeding polyunsaturated and saturated fat causes distinct effects on liver and visceral fat accumulation in humans. Diabetes 2014; 63: 2356-68.
  • 37. Takeuti TD, Terra GA, da Silva AA, Terra JA Jr, da Silva LM, Crema E. Effect of the ingestion of the palm oil and glutamine in serum levels of GLP-1, PYY and glycemia in diabetes mellitus type 2 patients submitted to metabolic surgery. Arq Bras Cir Dig 2014; 27(1): 51-5.
  • 38. Kumar KS, Raghavan M, Hieber K, Ege C, Mog S, Parra N, et al. Preferential radiation sensitization of prostate cancer in nude mice by nutraceutical antioxidant gamma-tocotrienol. Life Sci 2009; 78: 2099-104.
  • 39. Komarasamy TV, Sekaran SD. The anti-proliferative effects of a palm oil-derived product and its mode of actions in human malignant melanoma MeWo cells. J Oleo Sci 2012; 61: 227-39.
  • 40. Balasundram N, Tan YA, Sambanthamurthi R, Sundram K, Samman S. Antioxidant properties of palm fruit extracts. Asia Pac J Clin Nutr 2005; 14: 319-24.
  • 41. Ji X, Usman A, Razalli NH, Sambanthamurthi R, Gupta SV. Oil palm phenolics (OPP) inhibit pancreatic cancer cell proliferation via suppression of NF-κB pathway. Anticancer Res 2015; 35(1): 97-106.
  • 42. Lim SW, Loh HS, Ting KN, Bradshaw TD, Zeenathul NA. Antiproliferation and induction of caspase-8-dependent mitochondria-mediated apoptosis by b-tocotrienol in human lung and brain cancer cell lines. Biomed Pharmacother 2014; 68: 1105–15.
  • 43. Tran AT, Ramalinga M, Kedir H, Clarke R, Kumar D. Autophagy inhibitor 3-methyladenine potentiates apoptosis induced by dietary tocotrienols in breast cancer cells. Eur J Nutr 2015; 54(2): 265–72.
  • 44. Sczaniecka AK, Brasky TM, Lampe JW, Patterson RE, White E. Dietary intake of specific fatty acids and breast cancer risk among postmenopausal women in the VITAL cohort. Nutr Cancer 2012; 64: 1131–42.
  • 45. EFSA [Internet]. Risks for human health related to the presence of 3- and 2-monochloropropanediol (MCPD), and their fatty acid esters, and glycidyl fatty acid esters in food 2016 [Cited: 2017 Oct 10]. Available from: https://www.efsa.europa.eu/en/efsajournal/pub/4426
  • 46. Cheng WW, Liu GQ, Wang LQ, Liu ZS. Glycidyl fatty acid esters in refined edible oils: A review on formation, occurrence, analysis, and elimination methods. Compr Rev Food Sci Food Saf 2017; 16(2): 263-81.
  • 47. Matthäus B. Use of palm oil for frying in comparison with other high‐stability oils. Eur J Lipid Sci Technol 2007; 109(4): 400-9.
  • 48. Nantha HS, Tisdell C. The orangutan–oil palm conflict: Economic constraints and opportunities for conservation. Biodivers Conserv 2009; 18(2): 487-502.
Toplam 48 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Derlemeler
Yazarlar

Emre Duman

Alev Keser

Yayımlanma Tarihi 6 Aralık 2018
Gönderilme Tarihi 19 Ocak 2018
Yayımlandığı Sayı Yıl 2018

Kaynak Göster

Vancouver Duman E, Keser A. Palm Yağı ve Sağlık Üzerine Etkileri. Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi. 2018;9(3):54-8.

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