Araştırma Makalesi
Hafif dereceli obstrüktif uyku apne sendromlu olgularda D vitamini suplemantasyonunun antropometrik ölçümler ve vücut bileşimine etkisi
Öz
Amaç: Bu çalışma hafif dereceli obstrüktif uyku apne sendromu (OSAS) tanısı alan olgularda D vitamini suplemantasyonunun antropometik ölçümler ve vücut bileşimine etkisini incelemek amacıyla yapılmıştır.
Gereç ve Yöntem: Polisomnografi ile hafif dereceli OSAS tanısı alan ve D vitamini düzeyi yetersiz olan 20 yetişkin erkek (19-64 yıl) çalışmaya dahil edilmiştir. Olgulara sekiz hafta süresince 50.000 IU/hafta D3 vitamini suplemantasyonu verilmiştir. Çalışma başında ve sonunda tüm olguların bazı antropometrik ölçümleri (vücut ağırlığı, boy uzunluğu, bel, kalça ve boyun çevresi) alınmış ve vücut bileşimi analizleri yapılmıştır. Enerji ve besin ögesi alımları çalışma başında ve sonunda alınan 3 günlük bireysel besin tüketim kayıtları ile hesaplanmıştır.
Bulgular: Serum D vitamini düzeyi başlangıçta 19,1±5,16 ng/mL iken suplemantasyon sonrası 41,6±10,25 ng/mL’ye yükselmiş ve olguların %90’nın D vitamini düzeyi normal sınırlara ulaşmıştır. D vitamini suplemantasyonu sonunda olguların antropometrik ölçümleri ve vücut bileşimlerinde anlamlı fark olmamıştır. D vitamini suplemantasyonu sonunda diyet enerji, protein, yağ alımlarında ve apne hipopne indeksinde anlamlı azalma saptanmıştır.
Sonuç: Hafif dereceli obstrüktif uyku apne sendromu tanısı alan olgularda D vitamini suplemantasyonun enerji ve besin ögesi alımını etkileyebileceği görülmüştür. Ayrıca yetişkin olgularda D vitamini suplemantasyonunun hastalık prognozuna olumlu etkisinin olabileceği düşünülmektedir. Ancak D vitamininin vücut bileşimi ve antropometrik ölçümler üzerine etkisini incelemek amacıyla daha büyük örneklem ile uzunlamasına yapılacak çalışmalara ihtiyaç vardır.
Anahtar Kelimeler
D vitamini obstrüktif uyku apne sendromu antropometrik ölçüm vücut bileşimi
Destekleyen Kurum
Yok
Teşekkür
Tüm katılımcılara teşekkür ederiz
Kaynakça
- 1. Salord N, Gasa M, Mayos M, Fortuna-Gutierrez AM, Montserrat JM, Sánchez-de-la-Torre M et al. Impact of OSA on biological markers in morbid obesity and metabolic syndrome. J Clin Sleep Med. 2014;10(3): 263-70.
- 2. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165(9):1217-39.
- 3. Drager LF, Lopes HF, Maki-Nunes C, Trombetta IC, Toschi-Dias E, Alves MJNN et al. The impact of obstructive sleep apnea on metabolic and inflammatory markers in consecutive patients with metabolic syndrome. PloS One. 2010;5(8):e12065.
- 4. Drager LF, Togeiro SM, Polotsky VY, Lorenzi-Filho G. Obstructive sleep apnea: a cardiometabolic risk in obesity and the metabolic syndrome. J Am Coll Cardiol. 2013;62(7):569-76.
- 5. Pillar G, Shehadeh N. Abdominal fat and sleep apnea: the chicken or the egg? Diabetes Care. 2008;31(7):303-9.
- 6. Kim JH, Koo YC, Cho HJ, Kang JW. Relationship between various anthropometric measures and apnea-hypopnea index in Korean men. Auris Nasus Larynx. 2017;45(2):295-300.
- 7. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284(23):3015-21.
- 8. Davidson TM, Patel MR. Waist circumference and sleep disordered breathing. Laryngoscope. 2008;118(2):339-47.
- 9. Leong WB, Arora T, Jenkinson D, ThomasA , Punamiya V, Banerjee D, et al. The prevalence and severity of obstructive sleep apnea in severe obesity: the impact of ethnicity. J Clin Sleep Med. 2013; 9(9):853-58.
- 10. Epstein LJ, Kristo D, Strollo PJ, Friedman N, Malhotra A, Patil SP, Ramar K et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263-76.
- 11. Yildirim Y, Yilmaz S, Güven M, Faruk K, Kara AV, Yilmaz Z et al. Evaluation of anthropometric and metabolic parameters in obstructive sleep apnea. Pulm Med. 2015;(1):1-6.
- 12. Araghi MH, Chen YF, Jagielski A, Choudhury S, Banerjee D, Hussain S et al. Effectiveness of lifestyle interventions on obstructive sleep apnea (OSA): systematic review and meta-analysis. Sleep. 2013;36(10): 1553-62.
- 13. Sharma SK, Agrawal S, Damodaran D, Sreenivas V, Kadhiravan T, Lakshmy R et al. CPAP for the metabolic syndrome in patients with obstructive sleep apnea. N Engl J Med. 2011;365(24):2277-86.
- 14. Cheng S, Massaro JM, Fox CS, Larson MG, Keyes MJ, McCabe EL et al. Adiposity, cardiometabolic risk, and vitamin D status: the Framingham Heart Study. Diabetes. 2009;59(1):242-48.
- 15. Caron‐Jobin M, Morisset AS, Tremblay A, Huot C, Légaré D, Tchernof A. Elevated serum 25 (OH) D concentrations, vitamin D, and calcium intakes are associated with reduced adipocyte size in women. Obesity. 2011;19(7):1335-41.
- 16. Schleithoff SS, Zittermann A, Tenderich G, Berthold HK, Stehle P, Koerfer R. Vitamin D supplementation improves cytokine profiles in patients with congestive heart failure: a double-blind, randomized, placebo-controlled trial. Am J Clin Nutr. 2006;83(4):754-9.
- 17. Von Hurst PR, Stonehouse W, Coad J. Vitamin D supplementation reduces insulin resistance in South Asian women living in New Zealand who are insulin resistant and vitamin D deficient–a randomised, placebo-controlled trial. Br J Nutr. 2010;103(4):549-55.
- 18. Wamberg L, Kampmann U, Stødkilde-Jørgensen H, Rejnmark L, Pedersen S, Richelsen B. Effects of vitamin D supplementation on body fat accumulation, inflammation, and metabolic risk factors in obese adults with low vitamin D levels—results from a randomized trial. Eur J Intern Med. 2013;24(7):644-49.
- 19. Persson LJP, Aanerud M, Hiemstra PS, Hardie JA, Bakke PS, Eagan TML. Chronic obstructive pulmonary disease is associated with low levels of vitamin D. PloS One. 2012; 7(6):e38934.
- 20. McCarty DE, Chesson AL, Jain SK, Marino AA. The link between vitamin D metabolism and sleep medicine. Sleep Med Rev. 2014;18(4):311-19.
- 21. Upala S, Sanguankeo A. Association between 25-Hydroxyvitamin D and Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis. J Clin Sleep Med. 2015;11(11):1347.
- 22. Goswami U, Ensrud KE, Paudel ML, Redline S, Schernhammer ES, Shikany JM et al. Vitamin D concentrations and obstructive sleep apnea in a multicenter cohort of older males. Ann Am Thorac Soc. 2016;13(5):712-18.
- 23. Grace C, Vincent R, Aylwin SJ. High prevalence of vitamin D insufficiency in a United Kingdom urban morbidly obese population: implications for testing and treatment. Surg Obes Relat Dis. 2014;10(2):355-60.
- 24. Kull M, Kallikorm R, Lember M. Body mass index determines sunbathing habits: implications on vitamin D levels. Intern Med J. 2009;39(4):256-58.
- 25. Neighbors CL, Noller MW, Song SA, Zaghi S, Neighbors J, Feldman D et al. Vitamin D and obstructive sleep apnea: a systematic review and meta-analysis. Sleep Med. 2017;43(1):100-8.
- 26. Ruehland WR, Rochford PD, O’donoghue FJ, Pierce RJ, Singh P, Thornton AT.The new AASM criteria for scoring hypopneas: impact on the apnea hypopnea index. Sleep. 2009; 32(2):150-7.
- 27. World Health Organization (WHO). Body mass index - BMI. Avaliable from: URL:https://www.who.int/gho/ncd/risk_factors/bmi_text/en/. Accessed: May 31,2020
- 28. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911-30.
- 29. Romero-Corral A, Caples SM, Lopez-Jimenez F, Somers VK. Interactions between obesity and obstructive sleep apnea: implications for treatment. Chest. 2010;137(3):711-9.
- 30. Fruh SM. Obesity: Risk factors, complications, and strategies for sustainable long‐term weight management. J Am Assoc Nurse Pract. 2017; 29(1):3-14.
- 31. Liguori C, Romigi A, Izzi F, Mercuri NB, Cordella A, Tarquini E et al. Continuous positive airway pressure treatment increases serum vitamin D levels in male patients with obstructive sleep apnea. J Clin Sleep Med. 2015;11(6):603-7.
- 32. Mutt SJ, Hyppönen E, Saarnio J, Järvelin MR, Herzig KH. Vitamin D and adipose tissue-more than storage. Front Physiol. 2014;24(5):228-37.
- 33. Kerley CP, Hutchinson K, Bolger K, McGowan A, Faul J, Cormican L. Serum vitamin D is significantly inversely associated with disease severity in Caucasian adults with obstructive sleep apnea syndrome. Sleep. 2016;39(2):293-300.
- 34. Verrusio W, Andreozzi P, Renzi A, Musumeci M, Gueli N, Cacciafesta M. Association between serum vitamin D and metabolic syndrome in middle-aged and older adults and role of supplementation therapy with vitamin D. Ann Ist Super Sanita. 2017;53(1):54-9.
- 35. Karefylakis C, Särnblad S, Ariander A, Ehlersson G, Rask E, Rask P. Effect of Vitamin D supplementation on body composition and cardiorespiratory fitness in overweight men-a randomized controlled trial. Endocrine. 2018;61(3):388-97.
- 36. Salehpour A, Hosseinpanah F, Shidfar F, Vafa M, Razaghi M, Dehghani S et al. A 12-week double-blind randomized clinical trial of vitamin D 3 supplementation on body fat mass in healthy overweight and obese women. Nutr J. 2012;11(1):78-86.
- 37. Roosta S, Kharadmand M, Teymoori F, Birjandi M, Adine A, Falahi E. Effect of vitamin D supplementation on anthropometric indices among overweight and obese women: A double blind randomized controlled clinical trial. Diabetes Metab Syndr. 2018;12(4):537-41.
- 38. Hajimohammadi M, Shab-Bidar S, Neyestani TR. Consumption of vitamin D-fortified yogurt drink increased leptin and ghrelin levels but reduced leptin to ghrelin ratio in type 2 diabetes patients: a single blind randomized controlled trial. Eur J Nutr. 2017;56(6):2029-36.
- 39. Ulutas O, Taskapan H, Taskapan MC, Temel I. Vitamin D deficiency, insulin resistance, serum adipokine, and leptin levels in peritoneal dialysis patients. Int Urol Nephrol. 2013;45(3):879-84.
- 40. Vasquez MM, Goodwin JL, Drescher AA, Smith TW, Quan SF. Associations of dietary intake and physical activity with sleep disordered breathing in the Apnea Positive Pressure Long-Term Efficacy Study (APPLES). J Clin Sleep Med. 2008;4(5): 411-8.
- 41. Shechter A. Obstructive sleep apnea and energy balance regulation: a systematic review. Sleep Med Rev. 2017;34(1):59-69.
- 42. Sneve M, Figenschau Y, Jorde R. Supplementation with cholecalciferol does not result in weight reduction in overweight and obese subjects. Eur J Endocrinol. 2008;159(6):675-84.
- 43. Abiaka C, Delghandi M, Kaur M, Al-Saleh M. Vitamin D status and anthropometric indices of an Omani study population. Sultan Qaboos Univ Med J. 2013; 13(2):224-31.
Effect of vitamin D supplementation on anthropometric measurements and body composition in patients with mild obstructive sleep apnea syndrome
Öz
Purpose: The aim of this study was to investigate the effect of vitamin D on anthropometric measurments and body composition in patients with mild obstructive sleep apnea syndrome (OSAS).
Materials and Methods: Twenty males (19-64 years) with mild OSAS after polysomnography and had low vitamin D levels were included. Patients were received weekly 50,000 IU vitamin D3 supplementation for eight weeks. Some anthropometric measurements of the patients (body weight, height, waist, hip and neck circumferences) and body composition measurements were taken. Three-day food records were taken from the patients. All measurements and records were taken both initial and end of the study.
Results: While serum vitamin D level was 19.1 ± 5.16 ng/mL at the beginning, it increased to 41.6 ± 10.25 ng / mL after supplementation. Also vitamin D level has reached normal limits in 90% of the patients. There was no significant difference in anthropometric measurement and body composition after vitamin D supplemantation. After vitamin D supplementation, a significant decrease was found in dietary energy, protein, fat intake and apnea hypopnea index.
Conclusion: Vitamin D supplementation may affect energy and nutrient intake in individuals diagnosed with mild obstructive sleep apnea syndrome. Also, vitamin D supplementation may have a positive effect on the disease prognosis. However, due to the effect of vitamin D on body composition and anthropometric measurements, longitudinal studies with larger sample are needed.
Anahtar Kelimeler
Kaynakça
- 1. Salord N, Gasa M, Mayos M, Fortuna-Gutierrez AM, Montserrat JM, Sánchez-de-la-Torre M et al. Impact of OSA on biological markers in morbid obesity and metabolic syndrome. J Clin Sleep Med. 2014;10(3): 263-70.
- 2. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165(9):1217-39.
- 3. Drager LF, Lopes HF, Maki-Nunes C, Trombetta IC, Toschi-Dias E, Alves MJNN et al. The impact of obstructive sleep apnea on metabolic and inflammatory markers in consecutive patients with metabolic syndrome. PloS One. 2010;5(8):e12065.
- 4. Drager LF, Togeiro SM, Polotsky VY, Lorenzi-Filho G. Obstructive sleep apnea: a cardiometabolic risk in obesity and the metabolic syndrome. J Am Coll Cardiol. 2013;62(7):569-76.
- 5. Pillar G, Shehadeh N. Abdominal fat and sleep apnea: the chicken or the egg? Diabetes Care. 2008;31(7):303-9.
- 6. Kim JH, Koo YC, Cho HJ, Kang JW. Relationship between various anthropometric measures and apnea-hypopnea index in Korean men. Auris Nasus Larynx. 2017;45(2):295-300.
- 7. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284(23):3015-21.
- 8. Davidson TM, Patel MR. Waist circumference and sleep disordered breathing. Laryngoscope. 2008;118(2):339-47.
- 9. Leong WB, Arora T, Jenkinson D, ThomasA , Punamiya V, Banerjee D, et al. The prevalence and severity of obstructive sleep apnea in severe obesity: the impact of ethnicity. J Clin Sleep Med. 2013; 9(9):853-58.
- 10. Epstein LJ, Kristo D, Strollo PJ, Friedman N, Malhotra A, Patil SP, Ramar K et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263-76.
- 11. Yildirim Y, Yilmaz S, Güven M, Faruk K, Kara AV, Yilmaz Z et al. Evaluation of anthropometric and metabolic parameters in obstructive sleep apnea. Pulm Med. 2015;(1):1-6.
- 12. Araghi MH, Chen YF, Jagielski A, Choudhury S, Banerjee D, Hussain S et al. Effectiveness of lifestyle interventions on obstructive sleep apnea (OSA): systematic review and meta-analysis. Sleep. 2013;36(10): 1553-62.
- 13. Sharma SK, Agrawal S, Damodaran D, Sreenivas V, Kadhiravan T, Lakshmy R et al. CPAP for the metabolic syndrome in patients with obstructive sleep apnea. N Engl J Med. 2011;365(24):2277-86.
- 14. Cheng S, Massaro JM, Fox CS, Larson MG, Keyes MJ, McCabe EL et al. Adiposity, cardiometabolic risk, and vitamin D status: the Framingham Heart Study. Diabetes. 2009;59(1):242-48.
- 15. Caron‐Jobin M, Morisset AS, Tremblay A, Huot C, Légaré D, Tchernof A. Elevated serum 25 (OH) D concentrations, vitamin D, and calcium intakes are associated with reduced adipocyte size in women. Obesity. 2011;19(7):1335-41.
- 16. Schleithoff SS, Zittermann A, Tenderich G, Berthold HK, Stehle P, Koerfer R. Vitamin D supplementation improves cytokine profiles in patients with congestive heart failure: a double-blind, randomized, placebo-controlled trial. Am J Clin Nutr. 2006;83(4):754-9.
- 17. Von Hurst PR, Stonehouse W, Coad J. Vitamin D supplementation reduces insulin resistance in South Asian women living in New Zealand who are insulin resistant and vitamin D deficient–a randomised, placebo-controlled trial. Br J Nutr. 2010;103(4):549-55.
- 18. Wamberg L, Kampmann U, Stødkilde-Jørgensen H, Rejnmark L, Pedersen S, Richelsen B. Effects of vitamin D supplementation on body fat accumulation, inflammation, and metabolic risk factors in obese adults with low vitamin D levels—results from a randomized trial. Eur J Intern Med. 2013;24(7):644-49.
- 19. Persson LJP, Aanerud M, Hiemstra PS, Hardie JA, Bakke PS, Eagan TML. Chronic obstructive pulmonary disease is associated with low levels of vitamin D. PloS One. 2012; 7(6):e38934.
- 20. McCarty DE, Chesson AL, Jain SK, Marino AA. The link between vitamin D metabolism and sleep medicine. Sleep Med Rev. 2014;18(4):311-19.
- 21. Upala S, Sanguankeo A. Association between 25-Hydroxyvitamin D and Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis. J Clin Sleep Med. 2015;11(11):1347.
- 22. Goswami U, Ensrud KE, Paudel ML, Redline S, Schernhammer ES, Shikany JM et al. Vitamin D concentrations and obstructive sleep apnea in a multicenter cohort of older males. Ann Am Thorac Soc. 2016;13(5):712-18.
- 23. Grace C, Vincent R, Aylwin SJ. High prevalence of vitamin D insufficiency in a United Kingdom urban morbidly obese population: implications for testing and treatment. Surg Obes Relat Dis. 2014;10(2):355-60.
- 24. Kull M, Kallikorm R, Lember M. Body mass index determines sunbathing habits: implications on vitamin D levels. Intern Med J. 2009;39(4):256-58.
- 25. Neighbors CL, Noller MW, Song SA, Zaghi S, Neighbors J, Feldman D et al. Vitamin D and obstructive sleep apnea: a systematic review and meta-analysis. Sleep Med. 2017;43(1):100-8.
- 26. Ruehland WR, Rochford PD, O’donoghue FJ, Pierce RJ, Singh P, Thornton AT.The new AASM criteria for scoring hypopneas: impact on the apnea hypopnea index. Sleep. 2009; 32(2):150-7.
- 27. World Health Organization (WHO). Body mass index - BMI. Avaliable from: URL:https://www.who.int/gho/ncd/risk_factors/bmi_text/en/. Accessed: May 31,2020
- 28. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911-30.
- 29. Romero-Corral A, Caples SM, Lopez-Jimenez F, Somers VK. Interactions between obesity and obstructive sleep apnea: implications for treatment. Chest. 2010;137(3):711-9.
- 30. Fruh SM. Obesity: Risk factors, complications, and strategies for sustainable long‐term weight management. J Am Assoc Nurse Pract. 2017; 29(1):3-14.
- 31. Liguori C, Romigi A, Izzi F, Mercuri NB, Cordella A, Tarquini E et al. Continuous positive airway pressure treatment increases serum vitamin D levels in male patients with obstructive sleep apnea. J Clin Sleep Med. 2015;11(6):603-7.
- 32. Mutt SJ, Hyppönen E, Saarnio J, Järvelin MR, Herzig KH. Vitamin D and adipose tissue-more than storage. Front Physiol. 2014;24(5):228-37.
- 33. Kerley CP, Hutchinson K, Bolger K, McGowan A, Faul J, Cormican L. Serum vitamin D is significantly inversely associated with disease severity in Caucasian adults with obstructive sleep apnea syndrome. Sleep. 2016;39(2):293-300.
- 34. Verrusio W, Andreozzi P, Renzi A, Musumeci M, Gueli N, Cacciafesta M. Association between serum vitamin D and metabolic syndrome in middle-aged and older adults and role of supplementation therapy with vitamin D. Ann Ist Super Sanita. 2017;53(1):54-9.
- 35. Karefylakis C, Särnblad S, Ariander A, Ehlersson G, Rask E, Rask P. Effect of Vitamin D supplementation on body composition and cardiorespiratory fitness in overweight men-a randomized controlled trial. Endocrine. 2018;61(3):388-97.
- 36. Salehpour A, Hosseinpanah F, Shidfar F, Vafa M, Razaghi M, Dehghani S et al. A 12-week double-blind randomized clinical trial of vitamin D 3 supplementation on body fat mass in healthy overweight and obese women. Nutr J. 2012;11(1):78-86.
- 37. Roosta S, Kharadmand M, Teymoori F, Birjandi M, Adine A, Falahi E. Effect of vitamin D supplementation on anthropometric indices among overweight and obese women: A double blind randomized controlled clinical trial. Diabetes Metab Syndr. 2018;12(4):537-41.
- 38. Hajimohammadi M, Shab-Bidar S, Neyestani TR. Consumption of vitamin D-fortified yogurt drink increased leptin and ghrelin levels but reduced leptin to ghrelin ratio in type 2 diabetes patients: a single blind randomized controlled trial. Eur J Nutr. 2017;56(6):2029-36.
- 39. Ulutas O, Taskapan H, Taskapan MC, Temel I. Vitamin D deficiency, insulin resistance, serum adipokine, and leptin levels in peritoneal dialysis patients. Int Urol Nephrol. 2013;45(3):879-84.
- 40. Vasquez MM, Goodwin JL, Drescher AA, Smith TW, Quan SF. Associations of dietary intake and physical activity with sleep disordered breathing in the Apnea Positive Pressure Long-Term Efficacy Study (APPLES). J Clin Sleep Med. 2008;4(5): 411-8.
- 41. Shechter A. Obstructive sleep apnea and energy balance regulation: a systematic review. Sleep Med Rev. 2017;34(1):59-69.
- 42. Sneve M, Figenschau Y, Jorde R. Supplementation with cholecalciferol does not result in weight reduction in overweight and obese subjects. Eur J Endocrinol. 2008;159(6):675-84.
- 43. Abiaka C, Delghandi M, Kaur M, Al-Saleh M. Vitamin D status and anthropometric indices of an Omani study population. Sultan Qaboos Univ Med J. 2013; 13(2):224-31.
Toplam 43 adet kaynakça vardır.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 31 Mart 2021 |
| Kabul Tarihi | 8 Eylül 2020 |
| Yayımlandığı Sayı | Yıl 2021 Cilt: 46 Sayı: 1 |
