Yıl: 2019 Cilt: 27 Sayı: 1 Sayfa Aralığı: 63 - 78 Metin Dili: Türkçe DOI: 10.26650/FNJN346677 İndeks Tarihi: 06-02-2020

Diyetle Alınan Fruktozun Kronik Hastalıkların Gelişmesinde ve Prognozunda Etkisi Var mıdır?

Öz:
Diyetteki fruktozun kaynakları bal, meyve ve sükrozun yanı sıra yüksek fruktozlu nişasta bazlı şeker iletatlandırılmış çeşitli yiyecek ve içeceklerdir. Fruktoz; diyetle alınan toplam enerji miktarı ile lipogeneziarttırarak obeziteye yol açabilmektedir. Alım dozu, süresi ve fruktozun kaynağına bağlı olarak, alınanfruktozun çoğu metabolize edilerek de novo lipit sentezine katılabilmektedir. Kan glikoz ve insülinseviyelerini etkileyerek insülin direnci oluşumu, non-alkolik karaciğer yağlanması ve böbrek hastalıklarıriskini de arttırabilmektedir. Ayrıca yüksek fruktoz tüketimi organizmadaki inflamatuar süreçleribaşlatabilmektedir. Öte yandan tipik batı tarzı diyette yüksek fruktozla birlikte yüksek yağlı veya tuzlubeslenme fruktozun kronik hastalıklar üzerindeki bu olası etkilerini arttırabilmektedir. Sonuç olarakklinik çalışmalarla tam olarak desteklenmemiş olsa da deneysel çalışmaların sonuçlarına göre yüksekmiktarda fruktoz alımının kronik hastalık riskini arttırabileceği düşünülmektedir. Ayrıca tipik batı tarzıyüksek yağlı, şekerli ve tuzlu diyetle birlikte fazla miktarda fruktoz tüketiminin obezite, kardiyovaskülerhastalıklar gibi kronik hastalıkların riskini arttırabileceği ve metabolik sendrom parametrelerini daha fazlakötüleştirebileceği unutulmamalıdır. Ancak sentetik fruktoz, yüksek miktarda alındığında bazı olumsuzmetabolik etkilere neden olabilse de kaynağı meyve ya da bal olan fruktozun yüksek miktarda tüketimindebu olumsuz etkiler görülmemekte ya da tüketim miktarına bağlı olarak daha az oluşabilmektedir.
Anahtar Kelime:

Konular: Hemşirelik

Is There an Effect of Dietary Fructose on Development and Prognosis of Chronic Diseases?

Öz:
Dietary sources of fructose are not only honey, fruit, sucrose, but also high fructose corn syrup in various foods and beverages. Total amount of daily fructose intake is rising by especially increasing use of high fructose corn syrup in the food industry. Fructose can lead to obesity by contributing to high-energy intake and lipogenesis in the body. Depending on the source of fructose, dose and duration, it was involved in de-novo lipid synthesis. Fructose may increase the risk of insulin resistance, non-alcoholic fatty liver and kidney diseases by affecting blood glucose and insulin levels. On the other hand, fructose may initiate inflammatory processes in the organism. In addition to these, fat or salt consisting typical western type diet with high fructose consumption, can increase the potential effect of fructose on chronic diseases. As a result, although it is not fully supported by clinical studies, it is thought that high amounts of fructose intake may increase the risk of chronic disease shown by experimental studies. Also it should be noted that beside high fructose, typical western-style high-fat and high-salt diet may increase the risk of chronic diseases such as obesity, cardiovascular diseases and worsen metabolic syndrome parameters. Furthermore, synthetic fructose, is able to cause some adverse metabolic effects when taken in large amounts; consumption of high amounts of fructose by fruit or honey these negative effects can be either not seen or less observed based on the amount.
Anahtar Kelime:

Konular: Hemşirelik
Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık
  • Aeberli, I., Gerber, P. A., Hochuli, M., Kohler, S., Haile, S. R., GouniBerthold, I., et al. (2011). Low to moderate sugar-sweetened beverage consumption impairs glucose and lipid metabolism and promotes inflammation in healthy young men: a randomized controlled trial. Am J Clin Nutr, 94(2), 479-485. [CrossRef]
  • Aune, D., Chan, D. S., Vieira, A. R., Navarro Rosenblatt, D. A., Vieira, R., Greenwood, D. C., et al. (2012). Dietary fructose, carbohydrates, glycemic indices and pancreatic cancer risk: a systematic review and meta-analysis of cohort studies. Ann Oncol, 23(10), 2536-2546. [CrossRef]
  • Baena, M., Sanguesa, G., Davalos, A., Latasa, M. J., Sala-Vila, A., Sanchez, R. M., et al. (2016). Fructose, but not glucose, impairs insulin signaling in the three major insulin-sensitive tissues. Sci Rep, 6, 1-15. [CrossRef]
  • Baena, M., Sanguesa, G., Hutter, N., Beltran, J. M., Sanchez, R. M., Roglans, N., et al. (2017). Liquid fructose in Western-diet-fed mice impairs liver insulin signaling and causes cholesterol and triglyceride loading without changing calorie intake and body weight. J Nutr Biochem, 40, 105-115. [CrossRef]
  • Balakumar, M., Raji, L., Prabhu, D., Sathishkumar, C., Prabu, P., Mohan, V., et al. (2016). High-fructose diet is as detrimental as high-fat diet in the induction of insulin resistance and diabetes mediated by hepatic/pancreatic endoplasmic reticulum (ER) stress. Mol Cell Biochem. 423(1-2), 93-104. [CrossRef]
  • Biggelaar, L. J., Eussen, S. J., Sep, S. J., Mari, A., Ferrannini, E., Dongen, M. C., et al. (2017). Associations of Dietary Glucose, Fructose, and Sucrose with beta-Cell Function, Insulin Sensitivity, and Type 2 Diabetes in the Maastricht Study. Nutrients, 9(4), pii: E380.
  • Busserolles, J., Gueux, E., Rock, E., Mazur, A., & Rayssiguier, Y. (2002). Substituting honey for refined carbohydrates protects rats from hypertriglyceridemic and prooxidative effects of fructose. J Nutr, 132(11), 3379-3382. [CrossRef]
  • Cabral, P. D., Hong, N. J., Hye Khan, M. A., Ortiz, P. A., Beierwaltes, W. H., Imig, J. D., et al. (2014). Fructose stimulates Na/H exchange activity and sensitizes the proximal tubule to angiotensin II. Hypertension, 63(3), e68-73. [CrossRef] Cai, W., Li, J., Shi, J., Yang, B., Tang, J., Truby, H., et al. (2017).
  • Acute metabolic and endocrine responses induced by glucose and fructose in healthy young subjects: A doubleblinded, randomized, crossover trial. Clin Nutr. 37(2), 459- 470. [CrossRef]
  • Carran, E. L., White, S. J., Reynolds, A. N., Haszard, J. J., & Venn, B. J. (2016). Acute effect of fructose intake from sugarsweetened beverages on plasma uric acid: a randomised controlled trial. Eur J Clin Nutr, 70(9), 1034-1038. [CrossRef]
  • Catena, C., Cavarape, A., Novello, M., Giacchetti, G., & Sechi, L. A. (2003). Insulin receptors and renal sodium handling in hypertensive fructose-fed rats. Kidney Int, 64(6), 2163-2171. [CrossRef]
  • Chiavaroli, L., de Souza, R. J., Ha, V., Cozma, A. I., Mirrahimi, A., Wang, D. D., et al. (2015). Effect of fructose on established lipid targets: A systematic review and meta-analysis of controlled feeding trials. J Am Heart Assoc, 4(9), e001700. [CrossRef]
  • Chiu, S., Sievenpiper, J. L., de Souza, R. J., Cozma, A. I., Mirrahimi, A., Carleton, A. J., et al. (2014). Effect of fructose on markers of non-alcoholic fatty liver disease (NAFLD): A systematic review and meta-analysis of controlled feeding trials. Eur J Clin Nutr, 68(4), 416-423. [CrossRef]
  • Chung, M., Ma, J., Patel, K., Berger, S., Lau, J., & Lichtenstein, A. H. (2014). Fructose, high-fructose corn syrup, sucrose, and nonalcoholic fatty liver disease or indexes of liver health: A systematic review and meta-analysis. Am J Clin Nutr, 100(3), 833- 849. [CrossRef]
  • Coate, K. C., Smith, M. S., Shiota, M., Irimia, J. M., Roach, P. J., Farmer, B., et al. (2013). Hepatic glucose metabolism in late pregnancy: Normal versus high-fat and -fructose diet. Diabetes, 62(3), 753-761. [CrossRef]
  • Cozma, A. I., Sievenpiper, J. L., de Souza, R. J., Chiavaroli, L., Ha, V., Wang, D. D., et al. (2012). Effect of fructose on glycemic control in diabetes: a systematic review and meta-analysis of controlled feeding trials. Diabetes Care, 35(7), 1611-1620. [CrossRef]
  • Drewnowski, A., & Bellisle, F. (2007). Liquid calories, sugar, and body weight. Am J Clin Nutr, 85(3), 651-661. [CrossRef]
  • Dupas, J., Feray, A., Goanvec, C., Guernec, A., Samson, N., Bougaran, P., et al. (2017). Metabolic Syndrome and Hypertension Resulting from Fructose Enriched Diet in Wistar Rats. Biomed Res Int, 2017, 1-10. [CrossRef]
  • EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA); Scientific Opinion on Dietary Reference Values for carbohydrates and dietary fibre. (2010). EFSA Journal 8(3):1462[77 pp.].
  • EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA); Scientific Opinion on the substantiation of health claims related to fructose and reduction of post-prandial glycaemic responses (ID 558) pursuant to Article 13(1) of Regulation (EC) No 1924/2006. (2011). EFSA Journal, 9(6):2223. [15 pp.].
  • Fan, X., Liu, H., Liu, M., Wang, Y., Qiu, L., & Cui, Y. (2017). Increased utilization of fructose has a positive effect on the development of breast cancer. Peer J, 5, e3804. [CrossRef]
  • Francisqueti, F. V., Santos, K. C., Ferron, A. J., Lo, A. T., Minatel, I. O., Campos, D. H., et al. (2016). Fructose: Toxic effect on cardiorenal risk factors and redox state. SAGE Open Med, 4, 1-6. [CrossRef]
  • Fu, Y. C., Yin, S. C., Chi, C. S., Hwang, B., & Hsu, S. L. (2006). Norepinephrine induces apoptosis in neonatal rat endothelial cells via a ROS-dependent JNK activation pathway. Apoptosis, 11(11), 2053-2063. [CrossRef]
  • Gallagher, C., Keogh, J. B., Pedersen, E., & Clifton, P. M. (2016). Fructose acute effects on glucose, insulin, and triglyceride after a solid meal compared with sucralose and sucrose in a randomized crossover study. Am J Clin Nutr, 103(6), 1453-1457. [CrossRef]
  • Glushakova, O., Kosugi, T., Roncal, C., Mu, W., Heinig, M., Cirillo, P., et al. (2008). Fructose induces the inflammatory molecule ICAM-1 in endothelial cells. J Am Soc Nephrol, 19(9), 1712-1720. [CrossRef]
  • Grembecka, M. (2015). Natural sweeteners in a human diet. Rocz Panstw Zakl Hig, 66(3), 195-202.
  • Hacettepe Üniversitesi Beslenme ve Diyetetik Bölümü. (2015). Türkiye’ye Özgü Beslenme Rehberi. T.C. Sağlık Bakanlığı Temel Sağlık Hizmetleri Genel Müdürlüğü, 9-62. Ankara.
  • Hu, Q. H., Wang, C., Li, J. M., Zhang, D. M., & Kong, L. D. (2009). Allopurinol, rutin, and quercetin attenuate hyperuricemia and renal dysfunction in rats induced by fructose intake: renal organic ion transporter involvement. Am J Physiol Renal Physiol, 297(4), F1080-1091. [CrossRef]
  • Ibraheem, Z. O., Basir, R., Aljobory, A., Ibrahim, O. E., Alsumaidaee, A., & Yam, M. F. (2014). Impact of gentamicin coadministration along with high fructose feeding on progression of renal failure and metabolic syndrome in Sprague-Dawley rats. Biomed Res Int, 2014, 1-10. [CrossRef]
  • Jameel, F., Phang, M., Wood, L. G., & Garg, M. L. (2014). Acute effects of feeding fructose, glucose and sucrose on blood lipid levels and systemic inflammation. Lipids Health Dis, 13, 195. [CrossRef]
  • Jamnik, J., Rehman, S., Blanco Mejia, S., de Souza, R. J., Khan, T. A., et al. (2016). Fructose intake and risk of gout and hyperuricemia: a systematic review and meta-analysis of prospective cohort studies. BMJ Open, 6(10), e013191. [CrossRef]
  • Jayalath, V. H., de Souza, R. J., Ha, V., Mirrahimi, A., Blanco-Mejia, S., Di Buono, M., et al. (2015). Sugar-sweetened beverage consumption and incident hypertension: A systematic review and meta-analysis of prospective cohorts. Am J Clin Nutr, 102(4), 914-921. [CrossRef]
  • Jayalath, V. H., Sievenpiper, J. L., de Souza, R. J., Ha, V., Mirrahimi, A., Santaren, I. D., et al. (2014). Total fructose intake and risk of hypertension: a systematic review and meta-analysis of prospective cohorts. J Am Coll Nutr, 33(4), 328-339. [CrossRef]
  • Jegatheesan, P., & De Bandt, J. P. (2017). Fructose and NAFLD: The Multifaceted Aspects of Fructose Metabolism. Nutrients, 9(3), 1-13. [CrossRef]
  • Jin, R., Welsh, J. A., Le, N. A., Holzberg, J., Sharma, P., Martin, D. R., et al. (2014). Dietary fructose reduction improves markers of cardiovascular disease risk in Hispanic-American adolescents with NAFLD. Nutrients, 6(8), 3187-3201. [CrossRef]
  • Johnson, R. J., Perez-Pozo, S. E., Sautin, Y. Y., Manitius, J., Sanchez-Lozada, L. G., Feig, D. I., et al. (2009). Hypothesis: Could excessive fructose intake and uric acid cause type 2 diabetes? Endocr Rev, 30(1), 96-116.
  • Kaneko, C., Ogura, J., Sasaki, S., Okamoto, K., Kobayashi, M., Kuwayama, K., et al. (2017). Fructose suppresses uric acid excretion to the intestinal lumen as a result of the induction of oxidative stress by NADPH oxidase activation. Biochim Biophys Acta, 1861(3), 559-566. [CrossRef]
  • Klein, A. V., & Kiat, H. (2015). The mechanisms underlying fructoseinduced hypertension: A review. J Hypertens, 33(5), 912-920. [CrossRef]
  • Kuzma, J. N., Cromer, G., Hagman, D. K., Breymeyer, K. L., Roth, C. L., Foster-Schubert, K. E., et al. (2016). No differential effect of beverages sweetened with fructose, high-fructose corn syrup, or glucose on systemic or adipose tissue inflammation in normal-weight to obese adults: a randomized controlled trial. Am J Clin Nutr, 104(2), 306-314. [CrossRef]
  • Harvey, Richard A.. (2007). Lippincott Biyokimya (Ulukaya E, Çev) Ankara: Nobel Tıp.
  • Leibowitz, A., Rehman, A., Paradis, P., & Schiffrin, E. L. (2013). Role of T regulatory lymphocytes in the pathogenesis of highfructose diet-induced metabolic syndrome. Hypertension, 61(6), 1316-1321. [CrossRef]
  • Liu, H., & Heaney, A. P. (2011). Refined fructose and cancer. Expert Opin Ther Targets, 15(9), 1049-1059. [CrossRef]
  • Livesey, G., & Taylor, R. (2008). Fructose consumption and consequences for glycation, plasma triacylglycerol, and body weight: Meta-analyses and meta-regression models of intervention studies. Am J Clin Nutr, 88(5), 1419-1437.
  • Lowndes, J., Sinnett, S., Pardo, S., Nguyen, V. T., Melanson, K. J., Yu, Z., et al. (2014). The effect of normally consumed amounts of sucrose or high fructose corn syrup on lipid profiles, body composition and related parameters in overweight/obese subjects. Nutrients, 6(3), 1128-1144. [CrossRef]
  • Madero, M., Arriaga, J. C., Jalal, D., Rivard, C., McFann, K., PerezMendez, O., et al. (2011). The effect of two energy-restricted diets, a low-fructose diet versus a moderate natural fructose diet, on weight loss and metabolic syndrome parameters: A randomized controlled trial. Metabolism, 60(11), 1551-1559. [CrossRef]
  • Matikainen, N., Soderlund, S., Bjornson, E., Bogl, L. H., Pietilainen, K. H., Hakkarainen, A., et al. (2017). Fructose intervention for 12 weeks does not impair glycemic control or incretin hormone responses during oral glucose or mixed meal tests in obese men. Nutr Metab Cardiovasc Dis, 27(6), 534-542. [CrossRef]
  • Nunes, P. M., Wright, A. J., Veltien, A., van Asten, J. J., Tack, C. J., Jones, J. G., et al. (2014). Dietary lipids do not contribute to the higher hepatic triglyceride levels of fructose- compared to glucose-fed mice. FASEB J, 28(5), 1988-1997. [CrossRef]
  • Pagidipati, N. J., Hess, C. N., Clare, R. M., Akerblom, A., Tricoci, P., Wojdyla, D., et al. (2017). An examination of the relationship between serum uric acid level, a clinical history of gout, and cardiovascular outcomes among patients with acute coronary syndrome. Am Heart J, 187, 53-61. [CrossRef]
  • Panasevich, M. R., Meers, G. M., Linden, M. A., Booth, F. W., Perfield, J. W., 2nd, Fritsche, K. L., et al. (2018). High Fat, High Fructose, High Cholesterol Feeding Causes Severe NASH and Cecal Microbiota Dysbiosis in Juvenile Ossabaw Swine. Am J Physiol Endocrinol Metab, 314(1), E78-E92. [CrossRef]
  • Perez-Pozo, S. E., Schold, J., Nakagawa, T., Sanchez-Lozada, L. G., Johnson, R. J., & Lillo, J. L. (2010). Excessive fructose intake induces the features of metabolic syndrome in healthy adult men: Role of uric acid in the hypertensive response. Int J Obes (Lond), 34(3), 454-461. [CrossRef]
  • Petta, S., Marchesini, G., Caracausi, L., Macaluso, F. S., Camma, C., Ciminnisi, S., et al. (2013). Industrial, not fruit fructose intake is associated with the severity of liver fibrosis in genotype 1 chronic hepatitis C patients. J Hepatol, 59(6), 1169-1176. [CrossRef]
  • Port, A. M., Ruth, M. R., & Istfan, N. W. (2012). Fructose consumption and cancer: Is there a connection? Curr Opin Endocrinol Diabetes Obes, 19(5), 367-374.
  • Rendeiro, C., Masnik, A. M., Mun, J. G., Du, K., Clark, D., Dilger, R. N., et al. (2015). Fructose decreases physical activity and increases body fat without affecting hippocampal neurogenesis and learning relative to an isocaloric glucose diet. Sci Rep, 5, 9589. [CrossRef]
  • Rippe, J. M., & Angelopoulos, T. J. (2016). Sugars, obesity, and cardiovascular disease: Results from recent randomized control trials. Eur J Nutr, 55(Suppl 2), 45-53. [CrossRef]
  • Sartorelli, D. S., Franco, L. J., Gimeno, S. G., Ferreira, S. R., Cardoso, M. A., & Japanese-Brazilian Diabetes Study, G. (2009). Dietary fructose, fruits, fruit juices and glucose tolerance status in Japanese-Brazilians. Nutr Metab Cardiovasc Dis, 19(2), 77-83. [CrossRef]
  • Seraphim, D. C. C., Punaro, G. R., Fernandes, T. O., Ginoza, M., Lopes, G. S., & Higa, E. M. S. (2017). Assessment of fructose overload in the metabolic profile and oxidative/nitrosative stress in the kidney of senescent female rats. Exp Gerontol, 99, 53-60. [CrossRef]
  • Shapiro, A., Mu, W., Roncal, C., Cheng, K. Y., Johnson, R. J., & Scarpace, P. J. (2008). Fructose-induced leptin resistance exacerbates weight gain in response to subsequent high-fat feeding. Am J Physiol Regul Integr Comp Physiol, 295(5), R1370-1375. [CrossRef]
  • Silbernagel, G., Machann, J., Haring, H. U., Fritsche, A., & Peter, A. (2014). Plasminogen activator inhibitor-1, monocyte chemoattractant protein-1, e-selectin and C-reactive protein levels in response to 4-week very-high-fructose or -glucose diets. Eur J Clin Nutr, 68(1), 97-100. [CrossRef]
  • Singh, A. K., Amlal, H., Haas, P. J., Dringenberg, U., Fussell, S., Barone, S. L., et al. (2008). Fructose-induced hypertension: essential role of chloride and fructose absorbing transporters PAT1 and Glut5. Kidney Int, 74(4), 438-447. [CrossRef]
  • Stanhope, K. L. (2012). Role of fructose-containing sugars in the epidemics of obesity and metabolic syndrome. Annu Rev Med, 63, 329-343. [CrossRef]
  • Stanhope, K. L., Schwarz, J. M., Keim, N. L., Griffen, S. C., Bremer, A. A., Graham, J. L., et al. (2009). Consuming fructosesweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. J Clin Invest, 119(5), 1322- 1334. [CrossRef]
  • Tappy, L., & Le, K. A. (2010). Metabolic effects of fructose and the worldwide increase in obesity. Physiol Rev, 90(1), 23-46. [CrossRef]
  • Tappy, L., Le, K. A., Tran, C., & Paquot, N. (2010). Fructose and metabolic diseases: new findings, new questions. Nutrition, 26(11-12), 1044-1049. [CrossRef]
  • Tasevska, N., Jiao, L., Cross, A. J., Kipnis, V., Subar, A. F., Hollenbeck, A., et al. (2012). Sugars in diet and risk of cancer in the NIH-AARP Diet and Health Study. Int J Cancer, 130(1), 159-169. [CrossRef]
  • Taylor, E. N., & Curhan, G. C. (2008). Fructose consumption and the risk of kidney stones. Kidney Int, 73(2), 207-212. [CrossRef]
  • Teff, K. L., Grudziak, J., Townsend, R. R., Dunn, T. N., Grant, R. W., Adams, S. H., et al. (2009). Endocrine and metabolic effects of consuming fructose- and glucose-sweetened beverages with meals in obese men and women: Influence of insulin resistance on plasma triglyceride responses. J Clin Endocrinol Metab, 94(5), 1562-1569. [CrossRef]
  • Ter Horst, K. W., Schene, M. R., Holman, R., Romijn, J. A., & Serlie, M. J. (2016). Effect of fructose consumption on insulin sensitivity in nondiabetic subjects: A systematic review and meta-analysis of diet-intervention trials. Am J Clin Nutr, 104(6), 1562-1576. [CrossRef]
  • Toop, C. R., & Gentili, S. (2016). Fructose Beverage Consumption Induces a Metabolic Syndrome Phenotype in the Rat: A Systematic Review and Meta-Analysis. Nutrients, 8(9), 1-15. [CrossRef]
  • Tran, L. T., MacLeod, K. M., & McNeill, J. H. (2014). Selective alpha(1)-adrenoceptor blockade prevents fructose-induced hypertension. Mol Cell Biochem, 392(1-2), 205-211. [CrossRef]
  • Wang, D. D., Sievenpiper, J. L., de Souza, R. J., Chiavaroli, L., Ha, V., Cozma, A. I., et al. (2012). The effects of fructose intake on serum uric acid vary among controlled dietary trials. J Nutr, 142(5), 916-923. [CrossRef]
  • Wang, H., Sun, R. Q., Zeng, X. Y., Zhou, X., Li, S., Jo, E., et al. (2015). Restoration of autophagy alleviates hepatic ER stress and impaired insulin signalling transduction in high fructose-fed male mice. Endocrinology, 156(1), 169-181. [CrossRef]
  • WHO (2015). Guideline: Sugars intake for adults and children. Geneva: World Health Organization.
  • Zubiria, M. G., Alzamendi, A., Moreno, G., Rey, M. A., Spinedi, E., & Giovambattista, A. (2016). Long-Term Fructose Intake Increases Adipogenic Potential: Evidence of Direct Effects of Fructose on Adipocyte Precursor Cells. Nutrients, 8(4), 198. [CrossRef]
APA YÜRÜK A, Nergiz Ünal R (2019). Diyetle Alınan Fruktozun Kronik Hastalıkların Gelişmesinde ve Prognozunda Etkisi Var mıdır?. , 63 - 78. 10.26650/FNJN346677
Chicago YÜRÜK Armağan Aytuğ,Nergiz Ünal Reyhan Diyetle Alınan Fruktozun Kronik Hastalıkların Gelişmesinde ve Prognozunda Etkisi Var mıdır?. (2019): 63 - 78. 10.26650/FNJN346677
MLA YÜRÜK Armağan Aytuğ,Nergiz Ünal Reyhan Diyetle Alınan Fruktozun Kronik Hastalıkların Gelişmesinde ve Prognozunda Etkisi Var mıdır?. , 2019, ss.63 - 78. 10.26650/FNJN346677
AMA YÜRÜK A,Nergiz Ünal R Diyetle Alınan Fruktozun Kronik Hastalıkların Gelişmesinde ve Prognozunda Etkisi Var mıdır?. . 2019; 63 - 78. 10.26650/FNJN346677
Vancouver YÜRÜK A,Nergiz Ünal R Diyetle Alınan Fruktozun Kronik Hastalıkların Gelişmesinde ve Prognozunda Etkisi Var mıdır?. . 2019; 63 - 78. 10.26650/FNJN346677
IEEE YÜRÜK A,Nergiz Ünal R "Diyetle Alınan Fruktozun Kronik Hastalıkların Gelişmesinde ve Prognozunda Etkisi Var mıdır?." , ss.63 - 78, 2019. 10.26650/FNJN346677
ISNAD YÜRÜK, Armağan Aytuğ - Nergiz Ünal, Reyhan. "Diyetle Alınan Fruktozun Kronik Hastalıkların Gelişmesinde ve Prognozunda Etkisi Var mıdır?". (2019), 63-78. https://doi.org/10.26650/FNJN346677
APA YÜRÜK A, Nergiz Ünal R (2019). Diyetle Alınan Fruktozun Kronik Hastalıkların Gelişmesinde ve Prognozunda Etkisi Var mıdır?. Florence Nightingale Hemşirelik Dergisi , 27(1), 63 - 78. 10.26650/FNJN346677
Chicago YÜRÜK Armağan Aytuğ,Nergiz Ünal Reyhan Diyetle Alınan Fruktozun Kronik Hastalıkların Gelişmesinde ve Prognozunda Etkisi Var mıdır?. Florence Nightingale Hemşirelik Dergisi 27, no.1 (2019): 63 - 78. 10.26650/FNJN346677
MLA YÜRÜK Armağan Aytuğ,Nergiz Ünal Reyhan Diyetle Alınan Fruktozun Kronik Hastalıkların Gelişmesinde ve Prognozunda Etkisi Var mıdır?. Florence Nightingale Hemşirelik Dergisi , vol.27, no.1, 2019, ss.63 - 78. 10.26650/FNJN346677
AMA YÜRÜK A,Nergiz Ünal R Diyetle Alınan Fruktozun Kronik Hastalıkların Gelişmesinde ve Prognozunda Etkisi Var mıdır?. Florence Nightingale Hemşirelik Dergisi . 2019; 27(1): 63 - 78. 10.26650/FNJN346677
Vancouver YÜRÜK A,Nergiz Ünal R Diyetle Alınan Fruktozun Kronik Hastalıkların Gelişmesinde ve Prognozunda Etkisi Var mıdır?. Florence Nightingale Hemşirelik Dergisi . 2019; 27(1): 63 - 78. 10.26650/FNJN346677
IEEE YÜRÜK A,Nergiz Ünal R "Diyetle Alınan Fruktozun Kronik Hastalıkların Gelişmesinde ve Prognozunda Etkisi Var mıdır?." Florence Nightingale Hemşirelik Dergisi , 27, ss.63 - 78, 2019. 10.26650/FNJN346677
ISNAD YÜRÜK, Armağan Aytuğ - Nergiz Ünal, Reyhan. "Diyetle Alınan Fruktozun Kronik Hastalıkların Gelişmesinde ve Prognozunda Etkisi Var mıdır?". Florence Nightingale Hemşirelik Dergisi 27/1 (2019), 63-78. https://doi.org/10.26650/FNJN346677