Journal of Traditional Medical Complementary Therapies

.: REVIEW
Dirençli Nişastanın İnflamatuar Bağırsak Hastalıkları ve Mikrobiyota Üzerine Etkisi
Effect of Resistant Starch on Inflammatory Bowel Diseases and Microbiota
Tuba TEKİNa, Mehmet FİSUNOĞLUb
aSivas Cumhuriyet Üniversitesi Sağlık Bilimleri Fakültesi, Beslenme ve Diyetetik Bölümü, Sivas, TÜRKİYE
bHacettepe Üniversitesi Sağlık Bilimleri Fakültesi, Beslenme ve Diyetetik Bölümü, Ankara, TÜRKİYE
J Tradit Complem Med. 2020;3(1):99-106
doi: 10.5336/jtracom.2019-72218
Article Language: TR
Full Text
ÖZET
 Dirençli nişasta, sağlıklı insanların ince bağırsaklarında sindirilmeyen ve emilmeyen, ancak kolondaki yerleşik mikroflora ile kolonda fermente edilen nişasta veya nişastalı gıda ürünlerinin toplamıdır. Dirençli nişastanın kolonda fermente olması sonucu doymuş alifatik organik asitler ailesine ait olan asetat, propiyonat ve bütirat gibi kısa zincirli yağ asitleri üretilmektedir. Dirençli nişasta, yararlı bakterilerin büyümesini ve aktivitesini uyarma, kısa zincirli yağ asitleri üretme gibi fonksiyonel özellikleri nedeni ile prebiyotik olarak kabul edilmektedir. Dirençli nişastanın vücut ağırlığı regülasyonunu sağladığı, insülin duyarlılığı ve glukoz yanıtını iyileştirdiği, kan lipid düzeyleri üzerinde düşürücü etki gösterdiği bilinmektedir. İnflamatuar bağırsak hastalıkları, gastrointestinal sistem içerisinde kronik veya tekrarlayan immün aktivasyon ve inflamasyon ile karakterizedir. Dirençli nişastanın, kolonda sağlığa yararlı bakterilerin büyümesini uyarması, patolojik etkileri baskılaması ve inflamatuar yanıtı düzenlemesi nedeni ile inflamatuar bağırsak hastalıkları üzerinde yararlı etkilerinin olabileceği düşünülmektedir. Gastrointestinal kanalda kolonize olan bakteri, virüs, mantar, protozoa gibi mikroorganizmalardan oluşan ve organ gibi işlev gören ekosistem, bağırsak mikrobiyotası olarak adlandırılmaktadır. Dirençli nişastanın kolonda fermentasyonuyla; safra asidi dönüşümünü ve bütirat konsantrasyonlarını artırdığı, bütiratın ise normal epitel hücre büyümesi ve kolonik hastalıkların önlenmesi için önemli olduğu kanıtlanmıştır. Ayrıca dirençli nişasta, sağlığa yararlı bakterilerin büyümesini sağlayarak mikrobiyota üzerinde olumlu etki göstermektedir. Mikrobiyotayı düzenlemesi nedeni ile dirençli nişastanın hem inflamatuar bağırsak hastalıkları hem de diğer kronik hastalıklar üzerinde yararlı etkilerinin olabileceği düşünülmektedir.

Anahtar Kelimeler: Dirençli nişasta; inflamatuar bağırsak hastalıkları; mikrobiyota; prebiyotikler
ABSTRACT
 Resistant starch is the sum of starch or starch food products that are not digested and absorbed in the small intestines of healthy people, but are fermented in the column by the microflora built into the colon. Fermentation of the resistant starch in the colon produces short chain fatty acids such as acetate, propionate and butyrate from the saturated family of aliphatic organic acids. Resistant starch is considered to be prebiotic because of its functional properties such as stimulating the growth and activity of beneficial bacteria and producing short chain fatty acids. Resistant starch is known to provide body weight regulation, improve insulin sensitivity and glucose response, and have a reducing effect on blood lipids. Inflammatory bowel diseases are characterized by chronic and recurrent immune activation and inflammation within the gastrointestinal tract. It is thought that resistant starch may have beneficial effects on inflammatory bowel diseases because it stimulates the growth of beneficial bacteria in the colon, suppresses pathological effects and regulates the inflammatory response. The ecosystem, which is composed of microorganisms such as bacteria, viruses, fungi and protozoa colonized in the gastrointestinal tract, is called the intestinal microbiota. Fermentation of resistant starch in the column; It increases bile acid conversion and butyrate concentrations. Butyrate has proven to be important for normal epithelial cell growth and prevention of colonic diseases. In addition, resistant starch has a positive effect on the microbiota by promoting the growth of health beneficial bacteria. Due to its microbiota regulation, it is thought to have beneficial effects on both inflammatory bowel diseases and other chronic diseases.

Keywords: Resistant starch; inflammatory bowel diseases; microbiota; prebiotics
REFERENCES:
  1. Lupton JR, Brooks JA, Butte NF, Caballero B, Flatt JP, Fried SK. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Washington, DC: National Academy Press: 2002;5:589-768.
  2. T.C. Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu, Obezite, Diyabet ve Metabolik Hastalıklar Daire Başkanlığı. Türkiye Beslenme Rehberi 2015 (TÜBER). T.C. Sağlık Bakanlığı, Yayın No: 1031. Ankara: Kayhan Ajans: 2016. p.157.
  3. Raigond P, Ezekiel R, Raigond B. Resistant starch in food: a review. J Sci Food Agric. 2015;95(10):1968-78. [Crossref]  [PubMed] 
  4. Dupuis JH, Liu Q, Yada RY. Methodologies for increasing the resistant starch content of food starches: a review. Comprehensive Reviews in Food Science and Food Safety (CRFSFS). 2014;13(6):1219-34. [Crossref] 
  5. Yang X, Darko KO, Huang Y, He C, Yang H, He S, et al. Resistant starch regulates gut microbiota: structure, biochemistry and cell signalling. Cell Physiol Biochem. 2017;42(1):306-18. [Crossref]  [PubMed] 
  6. Xia J, Zhu D, Wang R, Cui Y, Yan Y. Crop resistant starch and genetic improvement: a review of recent advances. Theor Appl Genet. 2018;131(12):2495-511. [Crossref]  [PubMed] 
  7. Türker B, Yeyinli Savlak N. [Resistant starch: types, sources, beneficial physiological effects and functional properties]. Akademik Gıda. 2015;13(4):354-9.
  8. Maa Z, Boye JI. Research advances on structural characterization of resistant starch and its structure-physiological function relationship: a review. Crit Rev Food Sci Nutr. 2018;58(7):1059-108. [Crossref]  [PubMed] 
  9. Okan Bakır B. [An overview to prebiotics, probiotics and synbiotic]. Beslenme ve Diyet Dergisi. 2012;40(2):178-82.
  10. de Sousa VMC, dos Santos EF, Sgarbieri VC. The importance of prebiotics in functional foods and clinical practice. Food Nutr Sci. 2011;2(2):133-44. [Crossref] 
  11. Keenan MJ, Zhou J, Hegsted M, Pelkman C, Durham HA, Coulon DB, et al. Role of resistant starch in improving gut health, adiposity, and insulin resistance. Adv Nutr. 2015;6(2):198-205. [Crossref]  [PubMed]  [PMC] 
  12. Higgins JA, Brown IL. Resistant starch: a promising dietary agent for the prevention/treatment of inflammatory bowel disease and bowel cancer. Curr Opin Gastroenterol. 2013;29(2):190-4. [Crossref]  [PubMed] 
  13. Moura FA, de Andrade KQ, Dos Santos JCF, Araújo ORP, Goulart MOF. Antioxidant therapy for treatment of inflammatory bowel disease: does it work? Redox Biol. 2015;6:617-39. [Crossref]  [PubMed]  [PMC] 
  14. Molodecky NA, Soon IS, Rabi DM, Ghali WA, Ferris M, Chernoff G, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142(1):46-54. [Crossref]  [PubMed] 
  15. Ayyıldız F, Ülker İ, Yılmaz B, Çakır Y, Akbulut G. [Intestinal diseases]. Akbulut G, editör. Gastrointestinal Sistem Hastalıklarında Tıbbi Beslenme Tedavisi. 1. Baskı. Ankara: Nobel Tıp Kitabevleri; 2017. p.327-33.
  16. Uranga JA, López-Miranda V, Lombó F, Abalo R. Food, nutrients and nutraceuticals affecting the course of inflammatory bowel disease. Pharmacol Rep. 2016;68(4):816-26. [Crossref]  [PubMed] 
  17. Bergeron F, Bouin M, D'Aoust L, Lemoyne M, Presse N. Food avoidance in patients with inflammatory bowel disease: what, when and who? Clin Nutr. 2018;37(3):884-9. [Crossref]  [PubMed] 
  18. Jacobasch G, Schmiedl D, Kruschewski M, Schmehl K. Dietary resistant starch and chronic inflammatory bowel diseases. Int J Colorectal Dis. 1999;14(4-5):201-11. [Crossref]  [PubMed] 
  19. Chapman MA, Grahn MF, Boyle MA, Hutton M, Rogers J, Williams NS. Butyrate oxidation is impaired in the colonic mucosa of sufferers of quiescent ulcerative colitis. Gut. 1994;35(1):73-6. [Crossref]  [PubMed]  [PMC] 
  20. Hamer HM, Jonkers D, Venema K, Vanhoutvin S, Troost FJ, Brummer RJ. Review article: the role of butyrate on colonic function. Aliment Pharm Ther. 2008;27(2):104-19. [Crossref]  [PubMed] 
  21. Bird AR, Conlon MA, Christophersen CT, Topping DL. Resistant starch, large bowel fermentation and a broader perspective of prebiotics and probiotics. Benef Microbes. 2010;1(4):423-431. [Crossref]  [PubMed] 
  22. Bassaganya-Riera J, DiGuardo M, Viladomiu M, de Horna A, Sanchez S, Einerhand AW, et al. Soluble fibers and resistant starch ameliorate disease activity in interleukin-10-deficient mice with inflammatory bowel disease. J Nutr. 2011;141(7):1318-25. [Crossref]  [PubMed] 
  23. Hu Y, Le Leu RK, Christophersen CT, Somashekar R, Conlon MA, Meng XQ, et al. Manipulation of the gut microbiota using resistant starch is associated with protection against colitis-associated colorectal cancer in rats. Carcinogenesis. 2016;37(4):366-75. [Crossref]  [PubMed] 
  24. Qian Y, Zhao X, Song JL, Zhu K, Sun P, Li GJ, et al. Inhibitory effects of resistant starch (RS3) as a carrier for stachyose on dextran sulfate sodium-induced ulcerative colitis in C57BL/6 mice. Exp Ther Med. 2013;6(5):1312-6. [Crossref]  [PubMed]  [PMC] 
  25. Shen D, Bai H, Li Z, Yu Y, Zhang H, Chen L. Positive effects of resistant starch supplementation on bowel function in healthy adults: a systematic review and meta-analysis of randomized controlled trials. Int J Food Sci Nutr. 2017;68(2):149-57. [Crossref]  [PubMed] 
  26. Majumder K, Fukuda T, Zhang H, Sakurai T, Taniguchi Y, Watanabe H, et al. Intervention of isomaltodextrin mitigates intestinal inflammation in a dextran sodium sulfate-induced mouse model of colitis via inhibition of toll-like receptor-4. J Agric Food Chem. 2017;65(4):810-7. [Crossref]  [PubMed] 
  27. Assisi RF; GISDI Study Group. Combined butyric acid/mesalazine treatment in ulcerative colitis with mild-moderate activity. Results of a multicentre pilot study. Minerva Gastroenterol Dietol. 2008;54(3):231-8.
  28. Özdemir A, Büyüktuncer Demirel Z. [The relation between diet and microbiota]. Journal of Biotechnology and Strategic Health Research (BSHR). 2017;1(Special issue):25-33.
  29. Tekin T, Çiçek B, Konyalıgil N. [The relationship between intestinal microbiota and obesity]. Journal of Health Sciences. 2018;27(1):95-9.
  30. Lesmes U, Beards EJ, Gibson GR, Tuohy KM, Shimoni E. Effects of resistant starch type III polymorphs on human colon microbiota and short chain fatty acids in human gut models. J Agric Food Chem. 2008;56(13):5415-21. [Crossref]  [PubMed] 
  31. Koay YC, Wali JA, Luk AWS, Macia L, Cogger VC, Pulpitel TJ, et al. Ingestion of resistant starch by mice markedly increases microbiome-derived metabolites. FASEB J. 2019;33(7):8033-42. [Crossref]  [PubMed] 
  32. Zeng H, Huang C, Lin S, Zheng M, Chen C, Zheng B, et al. Lotus seed resistant starch regulates gut microbiota and increases short-chain fatty acids production and mineral absorption in mice. J Agric Food Chem. 2017;65(42):9217-25. [Crossref]  [PubMed] 
  33. Paturi G, Nyanhanda T, Butts CA, Herath TD, Monro JA, Ansell J. Effects of potato fiber and potato-resistant starch on biomarkers of colonic health in rats fed diets containing red meat. J Food Sci. 2012;77(10):H216-23. [Crossref]  [PubMed] 
  34. Kieffer DA, Piccolo BD, Marco ML, Kim EB, Goodson ML, Keenan MJ, et al. Mice fed a high-fat diet supplemented with resistant starch display marked shifts in the liver metabolome concurrent with altered gut bacteria. J Nutr. 2016;146(12):2476-90. [Crossref]  [PubMed]  [PMC] 
  35. Maier TV, Lucio M, Lee LH, VerBerkmoes NC, Brislawn CJ, Bernhardt J, et al. Impact of dietary resistant starch on the human gut microbiome, metaproteome, and metabolome. mBio. 2017;8(5). pii: e01343-17. [Crossref]  [PubMed]  [PMC] 
  36. Zhang L, Ouyang Y, Li H, Shen L, Ni Y, Fang Q, et al. Metabolic phenotypes and the gut microbiota in response to dietary resistant starch type 2 in normal weight subjects: a randomized crossover trial. Sci Rep. 2019;9(1):4736. [Crossref]  [PubMed]  [PMC] 
  37. Ordiz MI, May TD, Mihindukulasuriya K, Martin J, Crowley J, Tarr PI, et al. The effect of dietary resistant starch type 2 on the microbiota and markers of gut inflammation in rural Malawi children. Microbiome. 2015;3(1):37-46. [Crossref]  [PubMed]  [PMC] 
  38. Vital M, Howe A, Bergeron N, Krauss RM, Jansson JK, Tiedje JM. Metagenomic insights into the degradation of resistant starch by human gut microbiota. Appl Environ Microbiol. 2018;84(23). pii: e01562-18. [Crossref]  [PubMed]  [PMC] 

.: Up To Date

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com