Turkiye Klinikleri Journal of Health Sciences

.: REVIEW
A Traditional Review of the Role of Nutrition in the Autism Spectrum Disorder
Otizm Spektrum Bozukluğunda Beslenmenin Rolü Üzerine Geleneksel Bir Derleme
Merve Esra ÇITAR DAZIROĞLUa, Adviye Gülçin SAĞDIÇOĞLU CELEPa, Cansu ÖZTÜRKb
aDepartment of Nutrition and Dietetics, Gazi University Faculty of Health Sciences, Ankara, TURKEY
bDepartment of Language and Speech Therapy, Yüksek İhtisas University Faculty of Health Sciences, Ankara, TURKEY
Turkiye Klinikleri J Health Sci. 2021;6(4):965-72
doi: 10.5336/healthsci.2021-82125
Article Language: EN
Full Text
ABSTRACT
Autism spectrum disorder (ASD) is a developmental disorder associated with individuals' inability to verbally and nonverbally communicate with their environment. ASD is accompanied by a number of neurological problems and immune disorders and various non-neurological comorbidities such as gastrointestinal system abnormalities. Besides, various nutritional problems, such as food selectivity, food rejection, food allergies and chewing and swallowing problems can be observed in these individuals. In addition to these nutritional problems, elimination diets like gluten-free and/or casein-free diet, specific carbohydrate diet, ketogenic diet and low oxalate diet, applied for therapeutic purposes greatly affect the nutritional status in ASD. Since these diets are aimed at eliminating various nutrients from the diet depending on their content, special care should be taken to ensure that individuals receive sufficient energy and nutrients. When necessary, it may be beneficial to supplement various vitamins and minerals, antioxidants, probiotic and omega-3 fatty acids under expert control. Especially, since children with ASD have inadequate dietary antioxidant intake and highly oxidative stress, antioxidant intake must be followed meticulously. Considering all this, since the effect of nutrition in ASD is very important and there is not enough information yet, it can be said that nutritional interventions should be made depending on the symptoms of the individual with ASD. It should be kept in mind that ASD symptoms can be alleviated with nutritional interventions. In this review, various nutritional problems, different dietary treatments and supplements in individuals with ASD are explained.

Keywords: Autism spectrum disorder; diet, food, and nutrition; dietary supplements; antioxidants
ÖZET
Otizm spektrum bozukluğu (OSB), bireylerin çevreleriyle sözlü ve sözlü olmayan iletişim kuramamaları ile ilişkili bir gelişimsel bozukluktur. OSB'ye birtakım nörolojik ve bağışıklık sistemi problemi ile gastrointestinal sistem anormallikleri gibi çeşitli nörolojik olmayan komorbiditeler eşlik etmektedir. Aynı zamanda bu bireylerde besin seçiciliği, besin reddi, besin alerjileri ve çiğneme ve yutma bozuklukları gibi çeşitli beslenme sorunları da görülebilmektedir. Beslenme sorunlarına ek olarak, tedavi amaçlı uygulanan glutensiz ve/veya kazeinsiz diyet, spesifik karbonhidrat diyeti, ketojenik diyet ve düşük oksalatlı diyet gibi eliminasyon diyetleri de beslenme durumunu büyük ölçüde etkilemektedir. Bu diyetler, içeriklerine bağlı olarak çeşitli besin maddelerini diyetten çıkarmayı amaçladığından, bireylerin yeterli enerji ve besin ögelerini almalarına özen gösterilmelidir. Gerektiğinde çeşitli vitamin ve mineralleri, antioksidanları, probiyotik ve omega-3 yağ asitlerini uzman kontrolünde takviye etmek faydalı olabilir. Özellikle otizmli çocuklarda oksidatif stresin yüksek, buna karşılık diyet antioksidan alımının yetersiz olmasından dolayı diyet antioksidan alımı da titizlikle takip edilmelidir. Tüm bunlar göz önüne alındığında, OSB'de beslenmenin etkisi çok büyüktür; fakat henüz bu alanda yeterli bir literatür bilgisi bulunmadığı için OSB olan bireyin, semptomlarına bağlı olarak beslenme müdahalelerinin yapılması gerektiği ve OSB belirtilerinin, beslenme müdahaleleri ile hafifletilebileceği unutulmamalıdır. Bu derlemede, OSB olan bireylerde görülen çeşitli beslenme sorunları ve uygulanan farklı diyet tedavileri ile destekler açıklanmıştır.

Anahtar Kelimeler: Otizm spektrum bozukluğu; diyet, besin ve beslenme; besin destekleri; antioksidanlar
REFERENCES:
  1. Kidd PM. Autism, an extreme challenge to integrative medicine. Part: 1: The knowledge base. Altern Med Rev. 2002;7(4):292-316. [PubMed] 
  2. Bauman ML. Medical comorbidities in autism: challenges to diagnosis and treatment. Neurotherapeutics. 2010;7(3):320-7. [Crossref] [PubMed] [PMC] 
  3. Kohane IS, McMurry A, Weber G, MacFadden D, Rappaport L, Kunkel L, et al. The co-morbidity burden of children and young adults with autism spectrum disorders. PLoS One. 2012;7(4):e33224. [Crossref] [PubMed] [PMC] 
  4. Grabrucker AM. Environmental factors in autism. Front Psychiatry. 2013;3:118. [Crossref] [PubMed] [PMC] 
  5. Vissoker RE, Latzer Y, Gal E. Eating and feeding problems and gastrointestinal dysfunction in autism spectrum disorders. Res Autism Spectr Disord. 2015;12:10-21. [Crossref] 
  6. Herbert MR, Buckley JA. Autism and dietary therapy: case report and review of the literature. J Child Neurol. 2013;28(8):975-82. [Crossref] [PubMed] 
  7. Kawicka A, Regulska-Ilow B. How nutritional status, diet and dietary supplements can affect autism. A review. Rocz Panstw Zakl Hig. 2013;64(1):1-12. [PubMed] 
  8. Chauhan A, Chauhan V, Brown WT, Cohen I. Oxidative stress in autism: increased lipid peroxidation and reduced serum levels of ceruloplasmin and transferrin--the antioxidant proteins. Life Sci. 2004;75(21):2539-49. [Crossref] [PubMed] 
  9. Sen S, Chakraborty R. The role of antioxidants in human health. In: Silvana A, Hepel M, eds. Oxidative Stress: Diagnostics, Prevention, and Therapy. ACS Symposium Series, Vol. 1083. Washington, DC: American Chemical Society; 2011. p.1-37. [Crossref] 
  10. Kanner L. Autistic disturbances of affective contact. Nervous Child. 1943;2(3):217-50. [Link] 
  11. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®): American Psychiatric Pub; 2013. J Physiother Res, Salvador. 2019;9(2):155-8. [Link] 
  12. Neggers YH. Increasing prevalence, changes in diagnostic criteria, and nutritional risk factors for autism spectrum disorders. ISRN Nutr. 2014;2014:514026. [Crossref] [PubMed] [PMC] 
  13. Developmental Disabilities Monitoring Network Surveillance Year 2010 Principal Investigators; Centers for Disease Control and Prevention (CDC). Prevalence of autism spectrum disorder among children aged 8 years - autism and developmental disabilities monitoring network, 11 sites, United States, 2010. MMWR Surveill Summ. 2014;63(2):1-21. [PubMed] 
  14. Baio J, Wiggins L, Christensen DL, Maenner MJ, Daniels J, Warren Z, et al. Prevalence of autism spectrum disorder among children aged 8 years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014. MMWR Surveill Summ. 2018;67(6):1-23. Erratum in: MMWR Morb Mortal Wkly Rep. 2018;67(19):564. Erratum in: MMWR Morb Mortal Wkly Rep. 2018;67(45):1280. [Crossref] [PubMed] [PMC] 
  15. Johnson CP, Myers SM; American Academy of Pediatrics Council on Children With Disabilities. Identification and evaluation of children with autism spectrum disorders. Pediatrics. 2007;120(5):1183-215. [Crossref] [PubMed] 
  16. Bölte S, Girdler S, Marschik PB. The contribution of environmental exposure to the etiology of autism spectrum disorder. Cell Mol Life Sci. 2019;76(7):1275-97. [Crossref] [PubMed] [PMC] 
  17. Newschaffer CJ, Croen LA, Daniels J, Giarelli E, Grether JK, Levy SE, et al. The epidemiology of autism spectrum disorders. Annu Rev Public Health. 2007;28:235-58. [Crossref] [PubMed] 
  18. Smalley SL, Asarnow RF, Spence MA. Autism and genetics. A decade of research. Arch Gen Psychiatry. 1988;45(10):953-61. [Crossref] [PubMed] 
  19. Herbert MR, Russo JP, Yang S, Roohi J, Blaxill M, Kahler SG, et al. Autism and environmental genomics. Neurotoxicology. 2006;27(5):671-84. [Crossref] [PubMed] 
  20. Fujiwara T, Morisaki N, Honda Y, Sampei M, Tani Y. Chemicals, nutrition, and autism spectrum disorder: a mini-review. Front Neurosci. 2016;10:174. [Crossref] [PubMed] [PMC] 
  21. Gardener H, Spiegelman D, Buka SL. Prenatal risk factors for autism: comprehensive meta-analysis. Br J Psychiatry. 2009;195(1):7-14. [Crossref] [PubMed] [PMC] 
  22. Rai D, Lee BK, Dalman C, Golding J, Lewis G, Magnusson C. Parental depression, maternal antidepressant use during pregnancy, and risk of autism spectrum disorders: population based case-control study. BMJ. 2013;346:f2059. [Crossref] [PubMed] [PMC] 
  23. Madsen KM, Hviid A, Vestergaard M, Schendel D, Wohlfahrt J, Thorsen P, et al. A population-based study of measles, mumps, and rubella vaccination and autism. N Engl J Med. 2002;347(19):1477-82. [Crossref] [PubMed] 
  24. Parker SK, Schwartz B, Todd J, Pickering LK. Thimerosal-containing vaccines and autistic spectrum disorder: a critical review of published original data. Pediatrics. 2004;114(3):793-804. Erratum in: Pediatrics. 2005;115(1):200. [Crossref] [PubMed] 
  25. Arts-Rodas D, Benoit D. Feeding problems in infancy and early childhood: Identification and management. Paediatr Child Health. 1998;3(1):21-7. [Crossref] [PubMed] [PMC] 
  26. Kodak T, Piazza CC. Assessment and behavioral treatment of feeding and sleeping disorders in children with autism spectrum disorders. Child Adolesc Psychiatr Clin N Am. 2008;17(4):887-905, x-xi. [Crossref] [PubMed] 
  27. Ledford JR, Gast DL. Feeding problems in children with autism spectrum disorders: a review. Focus on Autism and Other Developmental Disabilities. 2006;21(3):153-66. [Crossref] 
  28. Field D, Garland M, Williams K. Correlates of specific childhood feeding problems. J Paediatr Child Health. 2003;39(4):299-304. [Crossref] [PubMed] 
  29. Nicholls D, Bryant-Waugh R. Eating disorders of infancy and childhood: definition, symptomatology, epidemiology, and comorbidity. Child Adolesc Psychiatr Clin N Am. 2009;18(1):17-30. [Crossref] [PubMed] 
  30. Marí-Bauset S, Zazpe I, Mari-Sanchis A, Llopis-González A, Morales-Suárez-Varela M. Food selectivity in autism spectrum disorders: a systematic review. J Child Neurol. 2014;29(11):1554-61. [Crossref] [PubMed] 
  31. Jyonouchi H. Autism spectrum disorders and allergy: observation from a pediatric allergy/immunology clinic. Expert Rev Clin Immunol. 2010;6(3):397-411. [Crossref] [PubMed] 
  32. Chaidez V, Hansen RL, Hertz-Picciotto I. Gastrointestinal problems in children with autism, developmental delays or typical development. J Autism Dev Disord. 2014;44(5):1117-27. [Crossref] [PubMed] [PMC] 
  33. Lyall K, Van de Water J, Ashwood P, Hertz-Picciotto I. Asthma and allergies in children with autism spectrum disorders: results from the CHARGE study. Autism Res. 2015;8(5):567-74. [Crossref] [PubMed] [PMC] 
  34. Pennesi CM, Klein LC. Effectiveness of the gluten-free, casein-free diet for children diagnosed with autism spectrum disorder: based on parental report. Nutr Neurosci. 2012;15(2):85-91. [Crossref] [PubMed] 
  35. Dodrill P. Feeding problems and oropharyngeal dysphagia in children. J Gastroenterol Hepatol Res. 2014;3(5):1055-1060.[Link] 
  36. Arvedson JC. Evaluation of children with feeding and swallowing problems. Lang Speech Hear Serv Sch. 2000;31(1):28-41. [Crossref] [PubMed] 
  37. Panksepp J, Najam N, Soares F. Morphine reduces social cohesion in rats. Pharmacol Biochem Behav. 1979;11(2):131-4. [Crossref] [PubMed] 
  38. Elder JH. The gluten-free, casein-free diet in autism: an overview with clinical implications. Nutr Clin Pract. 2008-2009;23(6):583-8. [Crossref] [PubMed] 
  39. Hurwitz S. The gluten-free, casein-free diet and autism: limited return on family investment. J Early Interv. 2013;35(1):3-19. [Crossref] 
  40. Knivsberg AM, Reichelt KL, Høien T, Nødland M. A randomised, controlled study of dietary intervention in autistic syndromes. Nutr Neurosci. 2002;5(4):251-61. [Crossref] [PubMed] 
  41. Geraghty ME, Bates-Wall J, Ratliff-Schaub K, Lane AE. Nutritional interventions and therapies in autism: A spectrum of what we know: Part 2. Infant Child Adolesc. Nutr. 2010;2(2):120-33. [Crossref] 
  42. Bolton PF, Carcani-Rathwell I, Hutton J, Goode S, Howlin P, Rutter M. Epilepsy in autism: features and correlates. Br J Psychiatry. 2011;198(4):289-94. [Crossref] [PubMed] [PMC] 
  43. Li BM, Liu XR, Yi YH, Deng YH, Su T, Zou X, et al. Autism in Dravet syndrome: prevalence, features, and relationship to the clinical characteristics of epilepsy and mental retardation. Epilepsy Behav. 2011;21(3):291-5. [Crossref] [PubMed] 
  44. Tuchman R, Cuccaro M, Alessandri M. Autism and epilepsy: historical perspective. Brain Dev. 2010;32(9):709-18. [Crossref] [PubMed] 
  45. Viscidi EW, Triche EW, Pescosolido MF, McLean RL, Joseph RM, Spence SJ, et al. Clinical characteristics of children with autism spectrum disorder and co-occurring epilepsy. PLoS One. 2013;8(7):e67797. [Crossref] [PubMed] [PMC] 
  46. Rossignol DA, Frye RE. A review of research trends in physiological abnormalities in autism spectrum disorders: immune dysregulation, inflammation, oxidative stress, mitochondrial dysfunction and environmental toxicant exposures. Mol Psychiatry. 2012;17(4):389-401. [Crossref] [PubMed] [PMC] 
  47. Napoli E, Due-as N, Giulivi C. Potential therapeutic use of the ketogenic diet in autism spectrum disorders. Front Pediatr. 2014;2:69. [Crossref] [PubMed] [PMC] 
  48. Walczyk T, Wick JY. The ketogenic diet: making a comeback. Consult Pharm. 2017;32(7):388-96. [Crossref] [PubMed] 
  49. Konstantynowicz J, Porowski T, Zoch-Zwierz W, Wasilewska J, Kadziela-Olech H, Kulak W, et al. A potential pathogenic role of oxalate in autism. Eur J Paediatr Neurol. 2012;16(5):485-91. [Crossref] [PubMed] 
  50. Adams JB, Audhya T, McDonough-Means S, Rubin RA, Quig D, Geis E, et al. Effect of a vitamin/mineral supplement on children and adults with autism. BMC Pediatr. 2011;11:111. [Crossref] [PubMed] [PMC] 
  51. Peretti S, Mariano M, Mazzocchetti C, Mazza M, Pino MC, Verrotti Di Pianella A, et al. Diet: the keystone of autism spectrum disorder? Nutr Neurosci. 2019;22(12):825-39. [Crossref] [PubMed] 
  52. Saad K, Abdel-Rahman AA, Elserogy YM, Al-Atram AA, Cannell JJ, Bjørklund G, et al. Vitamin D status in autism spectrum disorders and the efficacy of vitamin D supplementation in autistic children. Nutr Neurosci. 2016;19(8):346-51. [Crossref] [PubMed] 
  53. Uyanik O, Dogangun B, Kayaalp L, Korkmaz B, Dervent A. Food faddism causing vision loss in an autistic child. Child Care Health Dev. 2006;32(5):601-2. [Crossref] [PubMed] 
  54. Dolske MC, Spollen J, McKay S, Lancashire E, Tolbert L. A preliminary trial of ascorbic acid as supplemental therapy for autism. Prog Neuropsychopharmacol Biol Psychiatry. 1993;17(5):765-74. [Crossref] [PubMed] 
  55. Muhle R, Trentacoste SV, Rapin I. The genetics of autism. Pediatrics. 2004;113(5):e472-86. [Crossref] [PubMed] 
  56. Palmieri L, Persico AM. Mitochondrial dysfunction in autism spectrum disorders: cause or effect? Biochim Biophys Acta. 2010;1797(6-7):1130-7. [Crossref] [PubMed] 
  57. Al-Gadani Y, El-Ansary A, Attas O, Al-Ayadhi L. Metabolic biomarkers related to oxidative stress and antioxidant status in Saudi autistic children. Clin Biochem. 2009;42(10-11):1032-40. [Crossref] [PubMed] 
  58. Ng F, Berk M, Dean O, Bush AI. Oxidative stress in psychiatric disorders: evidence base and therapeutic implications. Int J Neuropsychopharmacol. 2008;11(6):851-76. [Crossref] [PubMed] 
  59. Chauhan A, Chauhan V. Oxidative stress in autism. Pathophysiology. 2006;13(3):171-81. [Crossref] [PubMed] 
  60. Yorbik O, Sayal A, Akay C, Akbiyik DI, Sohmen T. Investigation of antioxidant enzymes in children with autistic disorder. Prostaglandins Leukot Essent Fatty Acids. 2002;67(5):341-3. [Crossref] [PubMed] 
  61. Zoroglu SS, Armutcu F, Ozen S, Gurel A, Sivasli E, Yetkin O, et al. Increased oxidative stress and altered activities of erythrocyte free radical scavenging enzymes in autism. Eur Arch Psychiatry Clin Neurosci. 2004;254(3):143-7. [Crossref] [PubMed] 
  62. Cheh MA, Halladay AK, Yochum CL, Reuhl KR, Polunas M, Ming X, et al. Autism and oxidative stress: evidence from an animal model. Autism: oxidative stress, inflammation and immune abnormalities. In: Chauhan A, Chauhan V, Brown WT, eds. Autism: Oxidative Stress, Inflamation and Immune Abnormalities. 1st ed. New York: Taylor & Francis/CRC Press; 2010. p.133-53.[Link] 
  63. McGinnis WR. Oxidative stress in autism. Altern Ther Health Med. 2004;10(6):22-36; quiz 37, 92. [PubMed] 
  64. Mostafa GA, El-Hadidi ES, Hewedi DH, Abdou MM. Oxidative stress in Egyptian children with autism: relation to autoimmunity. J Neuroimmunol. 2010;219(1-2):114-8. [Crossref] [PubMed] 
  65. Raymond LJ, Deth RC, Ralston NV. Potential role of selenoenzymes and antioxidant metabolism in relation to autism etiology and pathology. Autism Res Treat. 2014;2014:164938. [Crossref] [PubMed] [PMC] 
  66. Cristiano C, Lama A, Lembo F, Mollica MP, Calignano A, Mattace Raso G. Interplay between peripheral and central inflammation in autism spectrum disorders: possible nutritional and therapeutic strategies. Front Physiol. 2018;9:184. [Crossref] [PubMed] [PMC] 
  67. Critchfield JW, van Hemert S, Ash M, Mulder L, Ashwood P. The potential role of probiotics in the management of childhood autism spectrum disorders. Gastroenterol Res Pract. 2011;2011:161358. [Crossref] [PubMed] [PMC] 
  68. Harris WS. Fish oil supplementation: evidence for health benefits. Cleve Clin J Med. 2004;71(3):208-10, 212, 215-8 passim. [Crossref] [PubMed] 
  69. Freeman MP, Hibbeln JR, Wisner KL, Davis JM, Mischoulon D, Peet M, et al. Omega-3 fatty acids: evidence basis for treatment and future research in psychiatry. J Clin Psychiatry. 2006;67(12):1954-67. Erratum in: J Clin Psychiatry. 2007;68(2):338. [Crossref] [PubMed] 

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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