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Çocukluk Çağı Astımında Obezite ve İnsülin Direncinin Astım Kontrolüne Etkisi

Yıl 2021, Cilt 21, Sayı 1, 34 - 41, 17.05.2021

Öz

Amaç: Son yıllarda dünyada ve Türkiye’de hem obezite hem de çocukluk çağı astım ve alerjik hastalıkların sıklığı giderek artmaktadır. Obezite ve insülin direnci enflamasyonun arttığı bir durumdur, astım için bir risk oluşturabilir ve astım kontrolüne etki edebilir. Bu çalışmada astım nedeniyle takip edilen ve vücut kitle indeksine göre gruplandırılan hastalarda obezite ve insülin direncinin astım kontrolü, ilaç gereksinimi ve yaşam kalitesi üzerine etkisinin araştırılması amaçlandı. Gereç ve Yöntem: En az bir yıldır astım tanısıyla takip edilen 7-18 yaş arası hastalar çalışmaya alındı. Hastalar vücut kitle indeksi persantiline göre obez, kilolu, normal kilolu olarak ayrıca HOMA-IR değerine göre insülin direnci açısından gruplandırıldı. Demografik özellikler ve laboratuvar sonuçları hasta dosyalarından elde edildi. Hastaların açlık glukoz, insülin, HOMA-IR, astım kontrol anketi, yaşam kalitesi anketi, kısa etkili β2 mimetik ihtiyacı, astım atak sayısı, acile başvuru gruplar arasında karşılaştırıldı. Bulgular: Çalısmaya 90’ı erkek 149 hasta alındı. Hastalın 25’ i obez 69’u kilolu olarak değerlendirildi. Astımlı obez hastaların astım kontrol anketi puanları, yaşam kalite anketi puanları astımlı normal kilolu olgulara göre daha düşük bulundu (p=0,038, p=0,050). Hastaların 59’unda insülin direnci saptandı. İnsülin direnci varlığına göre gruplandırılarak incelendiklerinde demografik özellikler, solunum fonksiyon testleri, deri delme test sonucu, astım kontrolü, yaşam kalitesi, astım şiddeti açısından anlamlı fark bulunmadı (p>0,05). Sonuç: Astımlı obez çocuklar daha fazla semptomatik, yaşam kalitesini daha fazla bozan, astım kontrolünün daha zor olduğu bir astım fenotipine sahip olabilirler bu nedenle ayrıcalıklı bir takibe ihtiyaç duyabilirler ve ilaç gereksinimleri farklılık gösterebilir.

Kaynakça

  • 1 .Lang JE, Bunnell HT, Hossain MJ, et al. Being overweight or obese and the development of asthma. Pediatrics. 2018;142(6):e20182119.
  • 2. Lobstein T, Jackson-Leach R, Moodie ML, et al. Child and adolescent obesity: part of a bigger picture. Lancet. 2015;385(9986):2510-2520.
  • 3. Fantuzzi G. Adipose tissue, adipokines, and inflammation. J Allergy Clin Immunol. 2005;115(5):911-920. 4. Ferrante AW Jr. Obesity-induced inflammation: a metabolic dialogue in the language of inflammation. J Intern Med. 2007;262(4):408-414.
  • 5. Bundak R, Furman A, Gunoz H, Darendeliler F, Bas F, Neyzi O. Body mass index references for Turkish children. Acta Paediatr. 2006 Feb;95(2):194-8.
  • 6. Kurtoğlu S, Hatipoğlu N, Mazıcıoğlu M, Kendirici M, Keskin M, Kondolot M. Insulin resistance in obese children and adolescents: HOMA-IR cut-off levels in the prepubertal and pubertal periods. J Clin Res Pediatr Endocrinol. 2010;2(3):100-106.
  • 7. Juniper EF, Guyatt GH, Feeny DH, Ferrie PJ, Griffith LE, Townsend M. Measuring quality of life in children with asthma. Qual Life Res. 1996;5(1):35-46.
  • 8. Juniper EF, Guyatt GH, Feeny DH, Griffith LE, Ferrie PJ. Minimum skills required by children to complete health-related quality of life instruments for asthma: comparison of measurement properties. Eur Respir J. 1997;10(10):2285-2294.
  • 9. Yüksel H, Yilmaz O, Kirmaz C, Eser E. Validity and reliability of the Turkish translation of the Pediatric Asthma Quality of Life Questionnaire. Turk J Pediatr. 2009;51(2):154-160.
  • 10. Sutherland ER. Obesity and asthma. Immunol Allergy Clin North Am. 2008;28(3):589-602
  • 11. Lang JE. Obesity and childhood asthma. Curr Opin Pulm Med 2019, 25:34–43.
  • 12. Hatun Ş. Çocukluk çağı obezitesinin dünya ve Türkiye’de sıklığı/durumu. Turkish J Pediatr Dis. 2012;1:7–14.
  • 13. Camargo CA Jr, Weiss ST, Zhang S, Willett WC, Speizer FE. Prospective study of body mass index, weight change, and risk of adult-onset asthma in women. Arch Intern Med. 1999;159(21):2582-2588.
  • 14. Beuther DA, Sutherland ER. Overweight, obesity, and incident asthma: a meta-analysis of prospective epidemiologic studies. Am J Respir Crit Care Med. 2007;175(7):661-666.
  • 15. Gold DR, Damokosh AI, Dockery DW, Berkey CS. Body-mass index as a predictor of incident asthma in a prospective cohort of children. Pediatr Pulmonol. 2003;36(6):514-521.
  • 16. Flaherman V, Rutherford GW. A meta-analysis of the effect of high weight on asthma. Arch Dis Child. 2006;91(4):334-339.
  • 17. Azizpour Y, Delpisheh A, Montazeri Z, Sayehmiri K, Darabi B. Effect of childhood BMI on asthma: a systematic review and meta-analysis of case-control studies. BMC Pediatr. 2018;18(1):143.
  • 18. Chinn S, Rona RJ. Can the increase in body mass index explain the rising trend in asthma in children?. Thorax. 2001;56(11):845-850.
  • 19. Çekiç Ş, Canıtez Y, Sapan N. Çocuklarda astım ve obezite ilişkisi. Çocuk Dergisi 2015;15(2):43-50.
  • 20. Çetemen A, Yenigün A, Ünüvar T, Gültekin B. The relationship between obesity, asthma and atopy in children aged 6-18 years. Asthma Allergy Immunol 2012;10:134-142.
  • 21. Yuksel H, Sogut A, Yilmaz O, Onur E, Dinc G. Role of adipokines and hormones of obesity in childhood asthma. Allergy Asthma Immunol Res. 2012;4(2):98-103.
  • 22. Bakırtaş A, Demi̇rsoy M, Bi̇deci̇ A, Ci̇naz P. 7 - 16 Yaş Çocuklarda Obezite Ve Allerjik Solunum Yolu Hastalığı İlişkisi. Türkiye Çocuk Hast Derg. 2007; 1(1): 5-10.
  • 23. Youssef DM, Elbehidy RM, Shokry DM, Elbehidy EM. The influence of leptin on Th1/Th2 balance in obese children with asthma. J Bras Pneumol. 2013;39(5):562-568.
  • 24. van Veen IH, Ten Brinke A, Sterk PJ, Rabe KF, Bel EH. Airway inflammation in obese and nonobese patients with difficult-to-treat asthma. Allergy. 2008;63(5):570-574.
  • 25. Lessard A, Turcotte H, Cormier Y, Boulet LP. Obesity and asthma: a specific phenotype?. Chest. 2008;134(2):317-323.
  • 26. Leung TF, Kong AP, Chan IH, et al. Association between obesity and atopy in Chinese schoolchildren. Int Arch Allergy Immunol. 2009;149(2):133-140.
  • 27. Van Gysel D, Govaere E, Verhamme K, Doli E, De Baets F. Body mass index in Belgian schoolchildren and its relationship with sensitization and allergic symptoms. Pediatr Allergy Immunol. 2009;20(3):246-253.
  • 28. Visness CM, London SJ, Daniels JL et all. Association of childhood obesity with atopic and nonatopic asthma: results from the National Health and Nutrition Examination Survey 1999-2006. J Asthma. 2010;47(7):822-9.
  • 29. Rastogi D. Pediatric obesity-related asthma: A prototype of pediatric severe non-T2 asthma. Pediatr Pulmonol. 2020 Mar;55(3):809-817.
  • 30. Guler N, Kirerleri E, Ones U, Tamay Z, Salmanyeli N, Darenderiler F. Leptin: Does it have any role in childhood asthma? J Allergy Clin Immunol 2004;114:254-259.
  • 31. Bekkers MB, Brunekreef B, de Jongste JC, et al. Childhood overweight and asthma symptoms, the role of proinflammatory proteins. Clin Exp Allergy 2012;42:95-103.
  • 32. Lugogo NL, Kraft M, Dixon AE. Does obesity produce a distinct asthma phenotype? J Appl Physiol 2010;108(3):729–734. 33. Celedon JC, Kolls JK. An innate link between obesity and asthma. Nature Medicine 2014;20(1):19-20.
  • 34. Anderson WJ, Lipworth BJ. Does body mass index influence responsiveness to inhaled corticosteroids in persistent asthma? Ann Allergy Asthma Immunol 2012;108:237-242.
  • 35. Martinez FD, Vercelli D. Asthma. Lancet. 2013;382(9901):1360-1372.
  • 36. Beydon N, Delclaux C. BMI as a comorbidity factor in childhood asthma. Expert Rev Respir Med 2012;6:569-571.
  • 37. Farah CS, Salome CM. Asthma and obesity: a known association but unknown mechanism. Respirology. 2012;17(3):412-421.
  • 38. Stenius-Aarniala B, Poussa T, Kvarnström J, Grönlund EL, Ylikahri M, Mustajoki P. Immediate and long term effects of weight reduction in obese people with asthma: randomised controlled study BMJ. 2000;320(7238):827-832.
  • 39. Scott HA, Gibson PG, Garg ML et al. Dietary restriction and exercise improve airway inflammation and clinical outcomes in overweight and obese asthma: a randomised trial. Clin Exp Allergy 2013;43:36-49.
  • 40. Black MH, Smith N, Porter AH, Jacobsen SJ, Koebnick C. Higher prevalence of obesity among children with asthma. Obesity (Silver Spring). 2012;20(5):1041-1047.
  • 41. Bibi H, Shoseyov D, Feigenbaum D et all. The relationship between asthma and obesity in children: is it real or a case of ever diagnosis? J Asthma 2004;41:403-10.
  • 42. Pionosi PT, Davis HS. Determinates of physical fitness in children with asthma. Pediatrics 2004;113:225-9.
  • 43. Quinto KB, Zuraw BL, Poon KT, Chen W, Schatz M, Christiansen SC. The association of obesity and asthma severity and control in children. J Allergy Clin Immunol 2011;128:964-9.
  • 44. Del-Rio-Navarro BE, Castro-Rodriguez JA, Garibay Nieto N, et all. Higher metabolic syndrome in obese asthmatic compared to obese non asthmatic adolescent males. J Asthma 2010 Jun;47(5):501-6.
  • 45. Cottrell L, Neal WA, Ice C, Perez MK, Piedimonte G. Metabolic abnormalities in children with asthma. Am J Respir Crit Med 2011;183:441-448.
  • 46. Singh S, Prakash YS, Linneberg A, Agrawal A. Insulin and the lung: connecting asthma and metabolic syndrome. J Allergy (Cairo). 2013;2013:627384.
  • 47. Ma J, Xiao S, Knowles B. Obesity, insulin resistance and the prevalance of atopy and asthma in US adults. Allergy 2010; 65:1455-1463.

The Effect of Obesity and Insulin Resistance on Asthma Control in Asthmatic Children

Yıl 2021, Cilt 21, Sayı 1, 34 - 41, 17.05.2021

Öz

Objective: In recent years, the prevalence of both obesity and asthma has increased in the pediatric population in Turkey and the whole world. Obesity and insulin resistance are conditions where inflammation increases and this may pose a risk for asthma and affect asthma control. The aim of this study was to investigate the effects of obesity and insulin resistance on asthma control, medication requirements, and the quality of life in patients who were followed up for asthma and classified according to body mass index. Material and Method: Patients aged 7-18 years who had been followed up for at least one year after a diagnosis of asthma were included in the study. Patients were categorised as being obese, overweight, or normal weight according to body mass index percentile, and insulin resistance according to HOMA-IR value. Demographic characteristics and laboratory test results were obtained from patient medical records. Fasting glucose, insulin, HOMA-IR, asthma control questionnaire, pediatric asthma quality of life questionnaire, short-acting β2 mimetic drug usage, asthma attack number, and admission to emergency service were compared between the groups. Results: One hundred and fourty-nine patients (90 male, 59 female) participated in the study. 25 of the patients were classed as obese and 69 as overweight. The asthma control questionnaire scores and the quality of life questionnaire scores of the obese patients with asthma were found to be lower than the normal weight asthmatic patients (p = 0.038, p = 0.050). Insulin resistance was detected in 59 patients. When asthmatic children were grouped according to the presence of insulin resistance, no significant differences were found in terms of demographic characteristics, respiratory function tests, skin puncture test results, asthma control, quality of life, and asthma severity (p>0.05). Conclusion: Obese asthmatic children may have an asthma phenotype that is more symptomatic and more difficult to control. These patients have a more impaired quality of life, so they may need a privileged followup and medication requirements may differ.

Kaynakça

  • 1 .Lang JE, Bunnell HT, Hossain MJ, et al. Being overweight or obese and the development of asthma. Pediatrics. 2018;142(6):e20182119.
  • 2. Lobstein T, Jackson-Leach R, Moodie ML, et al. Child and adolescent obesity: part of a bigger picture. Lancet. 2015;385(9986):2510-2520.
  • 3. Fantuzzi G. Adipose tissue, adipokines, and inflammation. J Allergy Clin Immunol. 2005;115(5):911-920. 4. Ferrante AW Jr. Obesity-induced inflammation: a metabolic dialogue in the language of inflammation. J Intern Med. 2007;262(4):408-414.
  • 5. Bundak R, Furman A, Gunoz H, Darendeliler F, Bas F, Neyzi O. Body mass index references for Turkish children. Acta Paediatr. 2006 Feb;95(2):194-8.
  • 6. Kurtoğlu S, Hatipoğlu N, Mazıcıoğlu M, Kendirici M, Keskin M, Kondolot M. Insulin resistance in obese children and adolescents: HOMA-IR cut-off levels in the prepubertal and pubertal periods. J Clin Res Pediatr Endocrinol. 2010;2(3):100-106.
  • 7. Juniper EF, Guyatt GH, Feeny DH, Ferrie PJ, Griffith LE, Townsend M. Measuring quality of life in children with asthma. Qual Life Res. 1996;5(1):35-46.
  • 8. Juniper EF, Guyatt GH, Feeny DH, Griffith LE, Ferrie PJ. Minimum skills required by children to complete health-related quality of life instruments for asthma: comparison of measurement properties. Eur Respir J. 1997;10(10):2285-2294.
  • 9. Yüksel H, Yilmaz O, Kirmaz C, Eser E. Validity and reliability of the Turkish translation of the Pediatric Asthma Quality of Life Questionnaire. Turk J Pediatr. 2009;51(2):154-160.
  • 10. Sutherland ER. Obesity and asthma. Immunol Allergy Clin North Am. 2008;28(3):589-602
  • 11. Lang JE. Obesity and childhood asthma. Curr Opin Pulm Med 2019, 25:34–43.
  • 12. Hatun Ş. Çocukluk çağı obezitesinin dünya ve Türkiye’de sıklığı/durumu. Turkish J Pediatr Dis. 2012;1:7–14.
  • 13. Camargo CA Jr, Weiss ST, Zhang S, Willett WC, Speizer FE. Prospective study of body mass index, weight change, and risk of adult-onset asthma in women. Arch Intern Med. 1999;159(21):2582-2588.
  • 14. Beuther DA, Sutherland ER. Overweight, obesity, and incident asthma: a meta-analysis of prospective epidemiologic studies. Am J Respir Crit Care Med. 2007;175(7):661-666.
  • 15. Gold DR, Damokosh AI, Dockery DW, Berkey CS. Body-mass index as a predictor of incident asthma in a prospective cohort of children. Pediatr Pulmonol. 2003;36(6):514-521.
  • 16. Flaherman V, Rutherford GW. A meta-analysis of the effect of high weight on asthma. Arch Dis Child. 2006;91(4):334-339.
  • 17. Azizpour Y, Delpisheh A, Montazeri Z, Sayehmiri K, Darabi B. Effect of childhood BMI on asthma: a systematic review and meta-analysis of case-control studies. BMC Pediatr. 2018;18(1):143.
  • 18. Chinn S, Rona RJ. Can the increase in body mass index explain the rising trend in asthma in children?. Thorax. 2001;56(11):845-850.
  • 19. Çekiç Ş, Canıtez Y, Sapan N. Çocuklarda astım ve obezite ilişkisi. Çocuk Dergisi 2015;15(2):43-50.
  • 20. Çetemen A, Yenigün A, Ünüvar T, Gültekin B. The relationship between obesity, asthma and atopy in children aged 6-18 years. Asthma Allergy Immunol 2012;10:134-142.
  • 21. Yuksel H, Sogut A, Yilmaz O, Onur E, Dinc G. Role of adipokines and hormones of obesity in childhood asthma. Allergy Asthma Immunol Res. 2012;4(2):98-103.
  • 22. Bakırtaş A, Demi̇rsoy M, Bi̇deci̇ A, Ci̇naz P. 7 - 16 Yaş Çocuklarda Obezite Ve Allerjik Solunum Yolu Hastalığı İlişkisi. Türkiye Çocuk Hast Derg. 2007; 1(1): 5-10.
  • 23. Youssef DM, Elbehidy RM, Shokry DM, Elbehidy EM. The influence of leptin on Th1/Th2 balance in obese children with asthma. J Bras Pneumol. 2013;39(5):562-568.
  • 24. van Veen IH, Ten Brinke A, Sterk PJ, Rabe KF, Bel EH. Airway inflammation in obese and nonobese patients with difficult-to-treat asthma. Allergy. 2008;63(5):570-574.
  • 25. Lessard A, Turcotte H, Cormier Y, Boulet LP. Obesity and asthma: a specific phenotype?. Chest. 2008;134(2):317-323.
  • 26. Leung TF, Kong AP, Chan IH, et al. Association between obesity and atopy in Chinese schoolchildren. Int Arch Allergy Immunol. 2009;149(2):133-140.
  • 27. Van Gysel D, Govaere E, Verhamme K, Doli E, De Baets F. Body mass index in Belgian schoolchildren and its relationship with sensitization and allergic symptoms. Pediatr Allergy Immunol. 2009;20(3):246-253.
  • 28. Visness CM, London SJ, Daniels JL et all. Association of childhood obesity with atopic and nonatopic asthma: results from the National Health and Nutrition Examination Survey 1999-2006. J Asthma. 2010;47(7):822-9.
  • 29. Rastogi D. Pediatric obesity-related asthma: A prototype of pediatric severe non-T2 asthma. Pediatr Pulmonol. 2020 Mar;55(3):809-817.
  • 30. Guler N, Kirerleri E, Ones U, Tamay Z, Salmanyeli N, Darenderiler F. Leptin: Does it have any role in childhood asthma? J Allergy Clin Immunol 2004;114:254-259.
  • 31. Bekkers MB, Brunekreef B, de Jongste JC, et al. Childhood overweight and asthma symptoms, the role of proinflammatory proteins. Clin Exp Allergy 2012;42:95-103.
  • 32. Lugogo NL, Kraft M, Dixon AE. Does obesity produce a distinct asthma phenotype? J Appl Physiol 2010;108(3):729–734. 33. Celedon JC, Kolls JK. An innate link between obesity and asthma. Nature Medicine 2014;20(1):19-20.
  • 34. Anderson WJ, Lipworth BJ. Does body mass index influence responsiveness to inhaled corticosteroids in persistent asthma? Ann Allergy Asthma Immunol 2012;108:237-242.
  • 35. Martinez FD, Vercelli D. Asthma. Lancet. 2013;382(9901):1360-1372.
  • 36. Beydon N, Delclaux C. BMI as a comorbidity factor in childhood asthma. Expert Rev Respir Med 2012;6:569-571.
  • 37. Farah CS, Salome CM. Asthma and obesity: a known association but unknown mechanism. Respirology. 2012;17(3):412-421.
  • 38. Stenius-Aarniala B, Poussa T, Kvarnström J, Grönlund EL, Ylikahri M, Mustajoki P. Immediate and long term effects of weight reduction in obese people with asthma: randomised controlled study BMJ. 2000;320(7238):827-832.
  • 39. Scott HA, Gibson PG, Garg ML et al. Dietary restriction and exercise improve airway inflammation and clinical outcomes in overweight and obese asthma: a randomised trial. Clin Exp Allergy 2013;43:36-49.
  • 40. Black MH, Smith N, Porter AH, Jacobsen SJ, Koebnick C. Higher prevalence of obesity among children with asthma. Obesity (Silver Spring). 2012;20(5):1041-1047.
  • 41. Bibi H, Shoseyov D, Feigenbaum D et all. The relationship between asthma and obesity in children: is it real or a case of ever diagnosis? J Asthma 2004;41:403-10.
  • 42. Pionosi PT, Davis HS. Determinates of physical fitness in children with asthma. Pediatrics 2004;113:225-9.
  • 43. Quinto KB, Zuraw BL, Poon KT, Chen W, Schatz M, Christiansen SC. The association of obesity and asthma severity and control in children. J Allergy Clin Immunol 2011;128:964-9.
  • 44. Del-Rio-Navarro BE, Castro-Rodriguez JA, Garibay Nieto N, et all. Higher metabolic syndrome in obese asthmatic compared to obese non asthmatic adolescent males. J Asthma 2010 Jun;47(5):501-6.
  • 45. Cottrell L, Neal WA, Ice C, Perez MK, Piedimonte G. Metabolic abnormalities in children with asthma. Am J Respir Crit Med 2011;183:441-448.
  • 46. Singh S, Prakash YS, Linneberg A, Agrawal A. Insulin and the lung: connecting asthma and metabolic syndrome. J Allergy (Cairo). 2013;2013:627384.
  • 47. Ma J, Xiao S, Knowles B. Obesity, insulin resistance and the prevalance of atopy and asthma in US adults. Allergy 2010; 65:1455-1463.

Ayrıntılar

Birincil Dil Türkçe
Konular Pediatri
Bölüm Araştırma Makaleleri
Yazarlar

Esra ÖZEK (Sorumlu Yazar)
İSTANBUL ÜNİVERSİTESİ, İSTANBUL TIP FAKÜLTESİ
0000-0003-3712-2522
Türkiye


Haluk ÇOKUĞRAŞ
İSTANBUL ÜNİVERSİTESİ - CERRAHPAŞA, CERRAHPAŞA TIP FAKÜLTESİ
0000-0002-0086-3936
Türkiye


Yıldız CAMCIOĞLU
İSTANBUL ÜNİVERSİTESİ - CERRAHPAŞA, CERRAHPAŞA TIP FAKÜLTESİ
0000-0002-4796-6828
Türkiye


Necla AKÇAKAYA
İSTANBUL ÜNİVERSİTESİ - CERRAHPAŞA, CERRAHPAŞA TIP FAKÜLTESİ
0000-0001-9904-2179
Türkiye

Yayımlanma Tarihi 17 Mayıs 2021
Yayınlandığı Sayı Yıl 2021, Cilt 21, Sayı 1

Kaynak Göster

Bibtex @araştırma makalesi { jchild835394, journal = {Çocuk Dergisi}, issn = {}, eissn = {1308-8491}, address = {Çocuk Dergisi Yayın Kurulu Sekreterliği İstanbul Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı Çapa, 34390, İstanbul}, publisher = {İstanbul Üniversitesi}, year = {2021}, volume = {21}, pages = {34 - 41}, doi = {}, title = {Çocukluk Çağı Astımında Obezite ve İnsülin Direncinin Astım Kontrolüne Etkisi}, key = {cite}, author = {Özek, Esra and Çokuğraş, Haluk and Camcıoğlu, Yıldız and Akçakaya, Necla} }
APA Özek, E. , Çokuğraş, H. , Camcıoğlu, Y. & Akçakaya, N. (2021). Çocukluk Çağı Astımında Obezite ve İnsülin Direncinin Astım Kontrolüne Etkisi . Çocuk Dergisi , 21 (1) , 34-41 . Retrieved from https://dergipark.org.tr/tr/pub/jchild/issue/60453/835394
MLA Özek, E. , Çokuğraş, H. , Camcıoğlu, Y. , Akçakaya, N. "Çocukluk Çağı Astımında Obezite ve İnsülin Direncinin Astım Kontrolüne Etkisi" . Çocuk Dergisi 21 (2021 ): 34-41 <https://dergipark.org.tr/tr/pub/jchild/issue/60453/835394>
Chicago Özek, E. , Çokuğraş, H. , Camcıoğlu, Y. , Akçakaya, N. "Çocukluk Çağı Astımında Obezite ve İnsülin Direncinin Astım Kontrolüne Etkisi". Çocuk Dergisi 21 (2021 ): 34-41
RIS TY - JOUR T1 - Çocukluk Çağı Astımında Obezite ve İnsülin Direncinin Astım Kontrolüne Etkisi AU - Esra Özek , Haluk Çokuğraş , Yıldız Camcıoğlu , Necla Akçakaya Y1 - 2021 PY - 2021 N1 - DO - T2 - Çocuk Dergisi JF - Journal JO - JOR SP - 34 EP - 41 VL - 21 IS - 1 SN - -1308-8491 M3 - UR - Y2 - 2021 ER -
EndNote %0 Çocuk Dergisi Çocukluk Çağı Astımında Obezite ve İnsülin Direncinin Astım Kontrolüne Etkisi %A Esra Özek , Haluk Çokuğraş , Yıldız Camcıoğlu , Necla Akçakaya %T Çocukluk Çağı Astımında Obezite ve İnsülin Direncinin Astım Kontrolüne Etkisi %D 2021 %J Çocuk Dergisi %P -1308-8491 %V 21 %N 1 %R %U
ISNAD Özek, Esra , Çokuğraş, Haluk , Camcıoğlu, Yıldız , Akçakaya, Necla . "Çocukluk Çağı Astımında Obezite ve İnsülin Direncinin Astım Kontrolüne Etkisi". Çocuk Dergisi 21 / 1 (Mayıs 2021): 34-41 .
AMA Özek E. , Çokuğraş H. , Camcıoğlu Y. , Akçakaya N. Çocukluk Çağı Astımında Obezite ve İnsülin Direncinin Astım Kontrolüne Etkisi. Çocuk Dergisi. 2021; 21(1): 34-41.
Vancouver Özek E. , Çokuğraş H. , Camcıoğlu Y. , Akçakaya N. Çocukluk Çağı Astımında Obezite ve İnsülin Direncinin Astım Kontrolüne Etkisi. Çocuk Dergisi. 2021; 21(1): 34-41.
IEEE E. Özek , H. Çokuğraş , Y. Camcıoğlu ve N. Akçakaya , "Çocukluk Çağı Astımında Obezite ve İnsülin Direncinin Astım Kontrolüne Etkisi", Çocuk Dergisi, c. 21, sayı. 1, ss. 34-41, May. 2021