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Vejetaryen Tip Beslenme ve Sağlık Üzerindeki Etkileri

Year 2022, Volume: 7 Issue: 1, 19 - 33, 30.04.2022

Abstract

Vejetaryen tip beslenmenin sağlık üzerindeki etkisi son zamanlarda birçok kişinin dikkatini çekmektedir. Bununla beraber, son yıllarda vejetaryen mutfağı ve bu yönde eğilim gösteren diyet uygulamaları daha fazla tercih edilir hale geldi, bazı sebepleri ise sağlık ve benzeri konular gösterilebilir. Vejetaryen tip beslenmenin sağlık üzerinde olumlu ve olumsuz etkileri vardır. Vejetaryen tip beslenmeyi tercih eden bireylerde en sık karşılaştığımız besin eksiklikleriden biri B12 vitamini eksikliğidir ve bu durum veganlarda daha sık görülür. Hem demirin alımı vejetaryenlerde az olsa da, diğer taraftan hem olmayan demir ve C vitamin alımının yüksek olması vejetaryenlerde anemi riskini artmaz. Çinko, diyet yağ asitleri ve D vitamini vejetaryen bireylerde alımı ve serum düzeylerine dikkat edilmesi gereken diğer mikrobesinlerdir. Bunlara rağmen, vejetaryen tip beslenmenin sağlık üzerinde olumlu etkileride gösterilmiştir. Vejetaryen tip bselenme yüksek miktarda posa ve oldukça az rafine şeker, işlenmiş besinler ve yağ asiteler içerdiği için, toplam, LDL ve HDL kolesterol değerlerinin azalmasında, yüksek tansiyonun düşmesinde, ağırlık kaybında ve glisemik kontrol ve denetiminde olumlu etkisi olduğu tespit edilmiştir. Ayrıca, vejetaryen tip beslenme ve mikrobiyota arasındaki ilişki son yıllarda dikkatleri üzerine çekmiştir. Diyet çeşit ve içerikleri hem bağırsak mikrobiyatası hem üretilen moleküllerin üzerinde etkilidir. Bu diyetler yüksek posa içerme sayesinde, gastrointestinal hormonlar özellikle inkretinler, postprandial insülin ve Tip 2 diyabet üzerinde önemli etkilere sahiptir. Vejetaryen diyetlerde enerji veya porsiyon kısıtlaması olmasa da, bu diyetlerin kardiyovasküler başta olmak üzere birçok kronik hastalık için risk faktörü olan obezite veya şişmanlık ve vücut yağlarının azalmasında rolü olduğu gösterilmiştir. Sonuç olarak vejetaryen tip beslenmenin diyet içeriğinden kaynaklanan besin eksiklikleri bireyelerde kaçınılmazdır ve biyerlerde sağlık komplikasiyonları oluşturabilir. Ancak bu eksiklikler ek destekler ile tamamlanırsa, sağlık üzerinde olumlu etkileri ortaya çıkabilir.

References

  • Barker, M., Robinson, S., Wilman, C., ve Barker, D. J. (2000). Behaviour, body composition and diet in adolescent girls. Appetite, 35 (2), 161-170. doi: 10.1006/appe.2000.0345
  • Barnard, N. D., Goldman, D. M., Loomis, J. F., Kahleova, H., Levin, S. M., Neabore, S., … Batts, T. C. (2019). Plant-based diets for cardiovascular safety and performance in endurance sports. Nutrients, 11(1). doi: 10.3390/nu11010130
  • Blancquaert, L., Baguet, A., Bex, T., Volkaert, A., Everaert, I., Delanghe, J., . . . Derave, W. (2018). Changing to a vegetarian diet reduces the body creatine pool in omnivorous women, but appears not to affect carnitine and carnosine homeostasis: a randomised trial. British Journal of Nutrition, 119 (7), 759-770. doi: 10.1017/S000711451800017X
  • Catharine Ross, Caballero, B., Cousins, R. J., Tucker, K. L., ve Ziegler, T. R. (2014). Modern nutrition in health and disease. (Eleventh ed.): Lippincott Williams ve Wilkins, a Wolters Kluwer.
  • Dinu, M., Abbate, R., Gensini, G. F., Casini, A., ve Sofi, F. (2017). Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies. Critical Reviews in Food Science and Nutrition, 57(17), 3640-3649. doi: 10.1080/10408398.2016.1138447
  • Foster, M., Chu, A., Petocz, P., ve Samman, S. (2013). Effect of vegetarian diets on zinc status: a systematic review and meta-analysis of studies in humans. Journal of the Science of Food and Agriculture, 93(10), 2362- 2371. doi: 10.1002/jsfa.6179
  • Foster, M., ve Samman, S. (2015). Vegetarian diets across the lifecycle: impact on zinc intake and status. Advances in Food and Nutrition Research, 74, 93-131. doi: 10.1016/bs.afnr.2014.11.003
  • Fox, N., ve Ward, K. (2008). Health, ethics and environment: a qualitative study of vegetarian motivations. Appetite, 50 (2-3), 422-429. doi: 10.1016/j.appet.2007.09.007
  • Gökçen, M., Aksoy, Y. A., ve Özcan, B. A. (2019). Vegan beslenme tarzına genel bakış. Sağlık ve Yaşam Bilimleri Dergisi, 1(2), 50-54. doi: 10.33308/2687248X.201912152
  • Haghighatdoost, F., Bellissimo, N., Totosy de Zepetnek, J. O., ve Rouhani, M. H. (2017). Association of vegetarian diet with inflammatory biomarkers: a systematic review and meta-analysis of observational studies. Public Health Nutrition, 20 (15), 2713-2721. doi: 10.1017/S1368980017001768
  • Hansen, T. H., Madsen, M. T. B., Jorgensen, N. R., Cohen, A. S., Hansen, T., Vestergaard, H., . . . Allin, K. H. (2018). Bone turnover, calcium homeostasis, and vitamin D status in Danish vegans. European Journal of Clinical Nutrition, 72 (7), 1046-1054. doi: 10.1038/s41430-017-0081-y
  • Hargreaves, S. M., Raposo, A., Saraiva, A., ve Zandonadi, R. P. (2021). Vegetarian diet: an overview through the perspective of quality of life domains. International Journal of Environmental Research and Public Health, 18 (8). doi: 10.3390/ijerph18084067
  • Harvard Health Publishing. (2020). Becoming a vegetarian. 19 Mart 2020 tarihinde https://www.health.harvard.edu/staying-healthy/becoming-a-vegetarian adresinden erişildi.
  • Hemler, E. C., ve Hu, F. B. (2019). Plant-Based diets for cardiovascular disease prevention: all plant foods are not created equal. Current Atherosclerosis Reports, 21 (5), 18. doi: 10.1007/s11883-019-0779-
  • Hsu, E. (2020). Plant-based diets and bone health: sorting through the evidence. Current Opinion in Endocrinology, Diabetes and Obesity, 27 (4), 248-252. doi: 10.1097/MED.0000000000000552
  • Huang, R. Y., Huang, C. C., Hu, F. B., ve Chavarro, J. E. (2016). Vegetarian Diets and Weight Reduction: a Meta-Analysis of Randomized Controlled Trials. Journal of General Internal Medicine, 31(1), 109-116. doi: 10.1007/s11606-015-3390-7
  • Hunt, J. R. (2003). Bioavailability of iron, zinc, and other trace minerals from vegetarian diets. The American Journal of Clinical Nutrition, 78(3 Suppl), 633-639. doi: 10.1093/ajcn/78.3.633S
  • Kahleova, H., Levin, S., ve Barnard, N. (2017). Cardio-metabolic benefits of plant-based diets. Nutrients, 9 (8). doi: 10.3390/nu9080848
  • Key, T. J., Appleby, P. N., ve Rosell, M. S. (2006). Health effects of vegetarian and vegan diets. Proceedings of the Nutrition Society, 65 (1), 35-41. doi: 10.1079/pns2005481
  • Lee, Y., ve Park, K. (2017). Adherence to a vegetarian diet and diabetes risk: a systematic review and meta-analysis of observational studies. Nutrients, 9 (6). doi: 10.3390/nu9060603
  • Mahan, L. K., ve Raymond, J. L. (2017). Krause's Food and the Nutrition Care Process (14th Edition ed.). St. Louis, Missouri: Elsevier.
  • Melina, V., Craig, W., ve Levin, S. (2016). Position of the academy of nutrition and dietetics: vegetarian diets. Journal of the Academy of Nutrition and Dietetics, 116 (12), 1970-1980. doi: 10.1016/j.jand.2016.09.025
  • Michalak, J., Zhang, X. C., ve Jacobi, F. (2012). Vegetarian diet and mental disorders: results from a representative community survey. International Journal of Behavioral Nutrition and Physical Activity, 9, 67. doi: 10.1186/1479-5868-9- 67
  • Orlich, M. J., Jaceldo-Siegl, K., Sabate, J., Fan, J., Singh, P. N., ve Fraser, G. E. (2014). Patterns of food consumption among vegetarians and non-vegetarians. British Journal of Nutrition, 112(10), 1644-1653. doi: 10.1017/S000711451400261X
  • Pawlak, R., Parrott, S. J., Raj, S., Cullum-Dugan, D., ve Lucus, D. (2013). How prevalent is vitamin B(12) deficiency among vegetarians? Nutrition Reviews, 71 (2), 110-117. doi: 10.1111/nure.12001
  • Ribeiro-Silva, R. C., Fiaccone, R. L., Conceicao-Machado, M., Ruiz, A. S., Barreto, M. L., ve Santana, M. L. P. (2018). Body image dissatisfaction and dietary patterns according to nutritional status in adolescents. Jornal de Pediatria (Rio J), 94 (2), 155-161. doi: 10.1016/j.jped.2017.05.005
  • Rogerson, D. (2017). Vegan diets: practical advice for athletes and exercisers. Journal of the International Society of Sports Nutrition, 14, 36. doi: 10.1186/s12970-017-0192-9
  • Rosenfeld, D. L., ve Burrow, A. L. (2017). Vegetarian on purpose: understanding the motivations of plant-based dieters. Appetite, 116, 456-463. doi: 10.1016/j.appet.2017.05.039
  • Salvador, A. M., Garcia-Maldonado, E., Gallego-Narbon, A., Zapatera, B., ve Vaquero, M. P. (2019). Fatty acid profile and cardiometabolic markers in relation with diet type and omega-3 supplementation in Spanish vegetarians. Nutrients, 11 (7). doi: 10.3390/nu11071659
  • Satija, A., Bhupathiraju, S. N., Spiegelman, D., Chiuve, S. E., Manson, J. E., Willett, W., . . . Hu, F. B. (2017). Healthful and unhealthful plant-based diets and the risk of coronary heart disease in U.S. adults. Journal of the American College of Cardiology, 70 (4), 411-422. doi: 10.1016/j.jacc.2017.05.047
  • Satija, A., ve Hu, F. B. (2018). Plant-based diets and cardiovascular health. Trends in Cardiovascular Medicine, 28 (7), 437-441. doi: 10.1016/j.tcm.2018.02.004
  • Saunders, A. V., Craig, W. J., Baines, S. K., ve Posen, J. S. (2013). Iron and vegetarian diets. Medical Journal of Australia, 199 (S4), 11-16. doi: 10.5694/mja11.11494
  • Savin, K. W., Zawadzki, J., Auldist, M. J., Wang, J., Ram, D., Rochfort, S., … Cocks, B. G. (2019). Faecalibacterium diversity in dairy cow milk. The Public Library of Science One, 14 (8), e0221055. doi: 10.1371/journal.pone.0221055
  • Sliwinska, A., Luty, J., Aleksandrowicz-Wrona, E., ve Malgorzewicz, S. (2018). Iron status and dietary iron intake in vegetarians. Advances in Clinical and Experimental Medicine, 27(10), 1383-1389. doi: 10.17219/acem/70527
  • Sobiecki, J. G., Appleby, P. N., Bradbury, K. E., ve Key, T. J. (2016). High compliance with dietary recommendations in a cohort of meat eaters, fish eaters, vegetarians, and vegans: results from the European Prospective Investigation into Cancer and Nutrition-Oxford study. Nutrition Research, 36 (5), 464-477. doi: 10.1016/j.nutres.2015.12.016
  • Sofi, F., Dinu, M., Pagliai, G., Cesari, F., Gori, A. M., Sereni, A., . . . Casini, A. (2018). Low-Calorie Vegetarian Versus Mediterranean Diets for Reducing Body Weight and Improving Cardiovascular Risk Profile: CARDIVEG Study (Cardiovascular Prevention With Vegetarian Diet). Circulation, 137(11), 1103-1113. doi: 10.1161/CIRCULATIONAHA.117.030088
  • Tucker, K. L. (2014). Vegetarian diets and bone status. The American Journal of Clinical Nutrition, 100(Suppl 1), 329-335. doi: 10.3945/ajcn.113.071621
  • Watanabe F. (2007). Vitamin B12 sources and bioavailability. Experimental biology and medicine (Maywood, N.J.), 232(10), 1266–1274. https://doi.org/10.3181/0703-MR-67
  • Yokoyama, Y., Levin, S. M., ve Barnard, N. D. (2017). Association between plant-based diets and plasma lipids: a systematic review and meta-analysis. Nutrition Reviews, 75 (9), 683-698. doi: https://doi.org/10.1093/nutrit/nux030
  • Zeuschner, C. L., Hokin, B. D., Marsh, K. A., Saunders, A. V., Reid, M. A., ve Ramsay, M. R. (2013). Vitamin B(1)(2) and vegetarian diets. Medical Journal of Australia, 199 (4), 27-32. doi: 10.5694/mja11.11509
Year 2022, Volume: 7 Issue: 1, 19 - 33, 30.04.2022

Abstract

References

  • Barker, M., Robinson, S., Wilman, C., ve Barker, D. J. (2000). Behaviour, body composition and diet in adolescent girls. Appetite, 35 (2), 161-170. doi: 10.1006/appe.2000.0345
  • Barnard, N. D., Goldman, D. M., Loomis, J. F., Kahleova, H., Levin, S. M., Neabore, S., … Batts, T. C. (2019). Plant-based diets for cardiovascular safety and performance in endurance sports. Nutrients, 11(1). doi: 10.3390/nu11010130
  • Blancquaert, L., Baguet, A., Bex, T., Volkaert, A., Everaert, I., Delanghe, J., . . . Derave, W. (2018). Changing to a vegetarian diet reduces the body creatine pool in omnivorous women, but appears not to affect carnitine and carnosine homeostasis: a randomised trial. British Journal of Nutrition, 119 (7), 759-770. doi: 10.1017/S000711451800017X
  • Catharine Ross, Caballero, B., Cousins, R. J., Tucker, K. L., ve Ziegler, T. R. (2014). Modern nutrition in health and disease. (Eleventh ed.): Lippincott Williams ve Wilkins, a Wolters Kluwer.
  • Dinu, M., Abbate, R., Gensini, G. F., Casini, A., ve Sofi, F. (2017). Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies. Critical Reviews in Food Science and Nutrition, 57(17), 3640-3649. doi: 10.1080/10408398.2016.1138447
  • Foster, M., Chu, A., Petocz, P., ve Samman, S. (2013). Effect of vegetarian diets on zinc status: a systematic review and meta-analysis of studies in humans. Journal of the Science of Food and Agriculture, 93(10), 2362- 2371. doi: 10.1002/jsfa.6179
  • Foster, M., ve Samman, S. (2015). Vegetarian diets across the lifecycle: impact on zinc intake and status. Advances in Food and Nutrition Research, 74, 93-131. doi: 10.1016/bs.afnr.2014.11.003
  • Fox, N., ve Ward, K. (2008). Health, ethics and environment: a qualitative study of vegetarian motivations. Appetite, 50 (2-3), 422-429. doi: 10.1016/j.appet.2007.09.007
  • Gökçen, M., Aksoy, Y. A., ve Özcan, B. A. (2019). Vegan beslenme tarzına genel bakış. Sağlık ve Yaşam Bilimleri Dergisi, 1(2), 50-54. doi: 10.33308/2687248X.201912152
  • Haghighatdoost, F., Bellissimo, N., Totosy de Zepetnek, J. O., ve Rouhani, M. H. (2017). Association of vegetarian diet with inflammatory biomarkers: a systematic review and meta-analysis of observational studies. Public Health Nutrition, 20 (15), 2713-2721. doi: 10.1017/S1368980017001768
  • Hansen, T. H., Madsen, M. T. B., Jorgensen, N. R., Cohen, A. S., Hansen, T., Vestergaard, H., . . . Allin, K. H. (2018). Bone turnover, calcium homeostasis, and vitamin D status in Danish vegans. European Journal of Clinical Nutrition, 72 (7), 1046-1054. doi: 10.1038/s41430-017-0081-y
  • Hargreaves, S. M., Raposo, A., Saraiva, A., ve Zandonadi, R. P. (2021). Vegetarian diet: an overview through the perspective of quality of life domains. International Journal of Environmental Research and Public Health, 18 (8). doi: 10.3390/ijerph18084067
  • Harvard Health Publishing. (2020). Becoming a vegetarian. 19 Mart 2020 tarihinde https://www.health.harvard.edu/staying-healthy/becoming-a-vegetarian adresinden erişildi.
  • Hemler, E. C., ve Hu, F. B. (2019). Plant-Based diets for cardiovascular disease prevention: all plant foods are not created equal. Current Atherosclerosis Reports, 21 (5), 18. doi: 10.1007/s11883-019-0779-
  • Hsu, E. (2020). Plant-based diets and bone health: sorting through the evidence. Current Opinion in Endocrinology, Diabetes and Obesity, 27 (4), 248-252. doi: 10.1097/MED.0000000000000552
  • Huang, R. Y., Huang, C. C., Hu, F. B., ve Chavarro, J. E. (2016). Vegetarian Diets and Weight Reduction: a Meta-Analysis of Randomized Controlled Trials. Journal of General Internal Medicine, 31(1), 109-116. doi: 10.1007/s11606-015-3390-7
  • Hunt, J. R. (2003). Bioavailability of iron, zinc, and other trace minerals from vegetarian diets. The American Journal of Clinical Nutrition, 78(3 Suppl), 633-639. doi: 10.1093/ajcn/78.3.633S
  • Kahleova, H., Levin, S., ve Barnard, N. (2017). Cardio-metabolic benefits of plant-based diets. Nutrients, 9 (8). doi: 10.3390/nu9080848
  • Key, T. J., Appleby, P. N., ve Rosell, M. S. (2006). Health effects of vegetarian and vegan diets. Proceedings of the Nutrition Society, 65 (1), 35-41. doi: 10.1079/pns2005481
  • Lee, Y., ve Park, K. (2017). Adherence to a vegetarian diet and diabetes risk: a systematic review and meta-analysis of observational studies. Nutrients, 9 (6). doi: 10.3390/nu9060603
  • Mahan, L. K., ve Raymond, J. L. (2017). Krause's Food and the Nutrition Care Process (14th Edition ed.). St. Louis, Missouri: Elsevier.
  • Melina, V., Craig, W., ve Levin, S. (2016). Position of the academy of nutrition and dietetics: vegetarian diets. Journal of the Academy of Nutrition and Dietetics, 116 (12), 1970-1980. doi: 10.1016/j.jand.2016.09.025
  • Michalak, J., Zhang, X. C., ve Jacobi, F. (2012). Vegetarian diet and mental disorders: results from a representative community survey. International Journal of Behavioral Nutrition and Physical Activity, 9, 67. doi: 10.1186/1479-5868-9- 67
  • Orlich, M. J., Jaceldo-Siegl, K., Sabate, J., Fan, J., Singh, P. N., ve Fraser, G. E. (2014). Patterns of food consumption among vegetarians and non-vegetarians. British Journal of Nutrition, 112(10), 1644-1653. doi: 10.1017/S000711451400261X
  • Pawlak, R., Parrott, S. J., Raj, S., Cullum-Dugan, D., ve Lucus, D. (2013). How prevalent is vitamin B(12) deficiency among vegetarians? Nutrition Reviews, 71 (2), 110-117. doi: 10.1111/nure.12001
  • Ribeiro-Silva, R. C., Fiaccone, R. L., Conceicao-Machado, M., Ruiz, A. S., Barreto, M. L., ve Santana, M. L. P. (2018). Body image dissatisfaction and dietary patterns according to nutritional status in adolescents. Jornal de Pediatria (Rio J), 94 (2), 155-161. doi: 10.1016/j.jped.2017.05.005
  • Rogerson, D. (2017). Vegan diets: practical advice for athletes and exercisers. Journal of the International Society of Sports Nutrition, 14, 36. doi: 10.1186/s12970-017-0192-9
  • Rosenfeld, D. L., ve Burrow, A. L. (2017). Vegetarian on purpose: understanding the motivations of plant-based dieters. Appetite, 116, 456-463. doi: 10.1016/j.appet.2017.05.039
  • Salvador, A. M., Garcia-Maldonado, E., Gallego-Narbon, A., Zapatera, B., ve Vaquero, M. P. (2019). Fatty acid profile and cardiometabolic markers in relation with diet type and omega-3 supplementation in Spanish vegetarians. Nutrients, 11 (7). doi: 10.3390/nu11071659
  • Satija, A., Bhupathiraju, S. N., Spiegelman, D., Chiuve, S. E., Manson, J. E., Willett, W., . . . Hu, F. B. (2017). Healthful and unhealthful plant-based diets and the risk of coronary heart disease in U.S. adults. Journal of the American College of Cardiology, 70 (4), 411-422. doi: 10.1016/j.jacc.2017.05.047
  • Satija, A., ve Hu, F. B. (2018). Plant-based diets and cardiovascular health. Trends in Cardiovascular Medicine, 28 (7), 437-441. doi: 10.1016/j.tcm.2018.02.004
  • Saunders, A. V., Craig, W. J., Baines, S. K., ve Posen, J. S. (2013). Iron and vegetarian diets. Medical Journal of Australia, 199 (S4), 11-16. doi: 10.5694/mja11.11494
  • Savin, K. W., Zawadzki, J., Auldist, M. J., Wang, J., Ram, D., Rochfort, S., … Cocks, B. G. (2019). Faecalibacterium diversity in dairy cow milk. The Public Library of Science One, 14 (8), e0221055. doi: 10.1371/journal.pone.0221055
  • Sliwinska, A., Luty, J., Aleksandrowicz-Wrona, E., ve Malgorzewicz, S. (2018). Iron status and dietary iron intake in vegetarians. Advances in Clinical and Experimental Medicine, 27(10), 1383-1389. doi: 10.17219/acem/70527
  • Sobiecki, J. G., Appleby, P. N., Bradbury, K. E., ve Key, T. J. (2016). High compliance with dietary recommendations in a cohort of meat eaters, fish eaters, vegetarians, and vegans: results from the European Prospective Investigation into Cancer and Nutrition-Oxford study. Nutrition Research, 36 (5), 464-477. doi: 10.1016/j.nutres.2015.12.016
  • Sofi, F., Dinu, M., Pagliai, G., Cesari, F., Gori, A. M., Sereni, A., . . . Casini, A. (2018). Low-Calorie Vegetarian Versus Mediterranean Diets for Reducing Body Weight and Improving Cardiovascular Risk Profile: CARDIVEG Study (Cardiovascular Prevention With Vegetarian Diet). Circulation, 137(11), 1103-1113. doi: 10.1161/CIRCULATIONAHA.117.030088
  • Tucker, K. L. (2014). Vegetarian diets and bone status. The American Journal of Clinical Nutrition, 100(Suppl 1), 329-335. doi: 10.3945/ajcn.113.071621
  • Watanabe F. (2007). Vitamin B12 sources and bioavailability. Experimental biology and medicine (Maywood, N.J.), 232(10), 1266–1274. https://doi.org/10.3181/0703-MR-67
  • Yokoyama, Y., Levin, S. M., ve Barnard, N. D. (2017). Association between plant-based diets and plasma lipids: a systematic review and meta-analysis. Nutrition Reviews, 75 (9), 683-698. doi: https://doi.org/10.1093/nutrit/nux030
  • Zeuschner, C. L., Hokin, B. D., Marsh, K. A., Saunders, A. V., Reid, M. A., ve Ramsay, M. R. (2013). Vitamin B(1)(2) and vegetarian diets. Medical Journal of Australia, 199 (4), 27-32. doi: 10.5694/mja11.11509
There are 40 citations in total.

Details

Primary Language Turkish
Subjects Sports Nutrition
Journal Section Reviews
Authors

Aylar Kargar Mohammadinazhad

Gül Kızıltan

Publication Date April 30, 2022
Published in Issue Year 2022 Volume: 7 Issue: 1

Cite

APA Kargar Mohammadinazhad, A., & Kızıltan, G. (2022). Vejetaryen Tip Beslenme ve Sağlık Üzerindeki Etkileri. Başkent Üniversitesi Sağlık Bilimleri Fakültesi Dergisi, 7(1), 19-33.