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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 6  |  Issue : 2  |  Page : 150-156

Assessment of the relation between obesity, serum lipids, and dietary intake of vegetable oils


1 Department of Preventive and Social Medicine, GCS Medical College, Hospital and Research Centre, Ahmedabad, Gujarat, India
2 Department of Preventive and Social Medicine, Dr. M. K. Shah Medical College and Research Centre, Ahmedabad, Gujarat, India
3 Department of Preventive and Social Medicine, GMERS Medical College, Sola, Ahmedabad, Gujarat, India

Date of Submission18-Oct-2019
Date of Decision24-Feb-2020
Date of Acceptance02-Apr-2020
Date of Web Publication24-Dec-2020

Correspondence Address:
Dr. Rujul P Shukla
Department of Preventive and Social Medicine, GCS Medical College Hospital and Research Centre, Naroda Road, Ahmedabad - 380 025, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJCFM.IJCFM_79_19

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  Abstract 

Introduction: The study was conducted to assess the association between consumption of particular variety of cooking oil and its effect on serum lipid profile and also on body mass index (BMI).
Material and Methods: The study was conducted at one of the tertiary care hospitals, Ahmedabad city, India. Patients with ≥18 years age who were undergoing “lipid profile” test at central laboratory department of selected hospital and giving consent were the study participants. Details of serum lipid profile were taken from report along with which anthropometric measurements were done and details of diet were taken. Data were entered into MS Excel and were analyzed by frequency, contingency coefficient, and Fisher's exact test.
Results: Total 1000 participants were included in the study, among which 274 (27.4%) had raised lipid levels and 729 (72.9%) were preobese or obese. Association between variety of cooking oil used and cholesterol-high-density lipoprotein ratio revealed contingency coefficient value of 0.042 with P value of 0.416. Association between BMI and variety of cooking oil used revealed Fisher's exact value as 83.015 with P < 0.001.
Conclusion: Statistical association was not found between serum lipid profile and type of oil used for cooking. Obesity indices revealed significant statistical association with both variety of cooking oil used and serum lipid profile. Dyslipidemia was found to have statistical significant association with raised blood pressure and raised blood glucose.

Keywords: Body mass index, cholesterol, cooking oil, obesity, serum lipids


How to cite this article:
Dave VR, Shukla RP, Bhavsar S, Patel N, Sonaliya KN. Assessment of the relation between obesity, serum lipids, and dietary intake of vegetable oils. Indian J Community Fam Med 2020;6:150-6

How to cite this URL:
Dave VR, Shukla RP, Bhavsar S, Patel N, Sonaliya KN. Assessment of the relation between obesity, serum lipids, and dietary intake of vegetable oils. Indian J Community Fam Med [serial online] 2020 [cited 2021 Apr 23];6:150-6. Available from: https://www.ijcfm.org/text.asp?2020/6/2/150/304802


  Introduction Top


Cardiovascular diseases are leading cause of death worldwide due to increase in their prevalence in low-to-middle-income countries.[1] In India, it is increasing at an alarming rate that it accounts for 24% of total deaths among adults aged 25–69 years.[2] Joshi et al.[3] in their similar research in India found that 79% of participants had abnormalities in one of the lipid parameters, with 13.9% having hypercholesterolemia. Excessive level of blood cholesterol speeds up the atherogenesis and lowering the level of blood cholesterol reduces incidence of Coronary Heart Disease (CHD).[4] In case of CHD, low-to-very-low-fat and high-carbohydrate diet is usually recommended; however, there is strong support that moderate-fat diet can be as effective or even better than usual trend.[5],[6] Moreover, at present, available options for reducing obesity and improving blood lipid levels such as dietary therapy and physical exercise are long-term option and hence there is poor adherence.[7] Hence, a novel, effective, and safe strategy such as use of oil with specific fatty acid such as medium-chain fatty acid and mono- and polyunsaturated fatty acid has demonstrated antiobesogenic effect.[8]

Vegetable cooking oils are one of the most common food item consumed in India. Various types of oil are available such as cottonseed, groundnut, soybean, palm, and sunflower. Foods from animal source have cholesterol and rich in saturated fat, but foods from plant source such as vegetable oils do not have cholesterol and they contain more of unsaturated fatty acid.[9] It is generally believed that vegetable oils decrease plasma cholesterol levels although they differ in their cholesterol-lowering capacity. Further research suggests that it is not the amount of fat in diet that matters but it is the type of fat in diet.[10] Quite a few researches can be found which try to establish a relation between consumption of cooking oil and cholesterol level/anthropometric measurement. It is commonly observed in clinical practice that lean and thin individuals have dyslipidemia and obese persons may have normal lipid profile though both consuming the same type of oil. Hence, the present study was planned to find triangular relationship between obesity, serum lipids, and consumption of particular kind of oil with the following objectives.

Objectives

  1. To determine the prevalence of dyslipidemia among participants
  2. To assess the association between consumption of particular variety of cooking oil and its effect on lipid profile and also on body mass index (BMI)
  3. To assess the association between BMI and lipid profile.



  Material and Methods Top


The present study was a cross-sectional study, conducted at one of the tertiary care hospitals of Ahmedabad city, India. Necessary approval was sorted from the institutional ethics committee. A pretested questionnaire was used for data collection. Patients with ≥18 years of age who were undergoing “lipid profile” test at the central laboratory department of the selected hospital were the study participants. Inclusion criteria included all patients aged ≥18 years, referred by any specialty of selected tertiary care hospital to the central laboratory for lipid profile, and willing to give informed oral consent. Patients who were below 18 years or not willing to give informed oral consent were excluded from the study. Duration of the study was from July 2016 to November 2018. The sample size was predefined purposively as 1000 participants.

A pretested questionnaire was used to fill in details of study participants, which included their sociodemographic details, anthropometric measurements, and their investigation reports of blood test. Data were entered into MS Excel and were analyzed using IBM SPSS Statistics for Windows, Version 20.0., IBM Corp., Armonk, NY, USA.

In the study, cutoff for lipid profile results were based on report of the National Cholesterol Education Program Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults.[11]

Similarly, formula to calculate and determine cutoff for various anthropometric measurements/obesity indices such as BMI, Broca's index, Lorentz index, Corpulence index, waist circumference, waist–hip ratio was taken from Park's Textbook of Preventive and Social Medicine, while for Ponderal index, it was obtained from Online Ponderal Index Calculator.[12],[13]

Criteria for diagnosing diabetes were based on the WHO recommendations for diagnostic criteria for diabetes and intermediate hyperglycemia.[12] Similarly, for diagnosing of hypertension, Government of India's developed Hypertension guidelines were used.[14]

For statistically testing the association between BMI/type of cooking oil used and lipid profile, cholesterol-high-density lipoprotein (HDL) ratio was taken as gold standard indicator. This is because studies have suggested these atherogenic disturbances may not be adequately reflected by variation in low-density lipoprotein (LDL)-HDL ratio or other indicators.[15],[16] The Socioeconomic Classification was done as per modified prasad classification. The value of All India Consumer Price Index for Industrial worker (AICPI - IW) was taken for June 2018 - the declared value was 291 by labour bureau, Govt.of India.[17]


  Results Top


In the present study, 1000 participants were interviewed and assessed. Sociodemographic profile of all participants is shown in [Table 1]. The mean age of participants was 47.86 ± 13.868 years. A detailed lipid profile of all the participants is described in [Table 2].
Table 1: Sociodemographic profile of the study participants (n=1000)

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Table 2: Lipid profile of the study participants (n=1000)

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Out of 593 participants having undergone fasting blood glucose level examination, 340 (57.3%) had normal level, 81 (13.7%) had impaired fasting blood glucose level, and 172 (29.0%) had uncontrolled fasting blood sugar level. Out of 294 participants having undergone postprandial blood glucose level examination, 91 (31.0%) had normal level, 40 (13.6%) had impaired postprandial blood glucose level, and 163 (55.4%) had uncontrolled postprandial blood sugar level. Out of 57 participants having undergone random blood sugar investigation, 54 (94.7%) had normal level and 3 (5.3%) had uncontrolled random blood sugar level. Hemoglobin A1c (HbA1C) report was done by 178 participants; out of which, 39 (21.9%) had normal level, 28 (15.7%) had well-controlled report, and 111 (62.4%) had poorly controlled HbA1C report. On examining blood pressure, 390 (39.0%) had raised blood pressure. In that, 116 (29.7%) had only raised systolic blood pressure, 75 (19.2%) had only raised diastolic blood pressure, and 199 (51.1%) had both systolic and diastolic raised blood pressure.

Obesity indices of all participants are shown in [Table 3].
Table 3: Distribution of the study participants according to various obesity indices (n=1000)

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On inquiring about personal history of participants, 615 (61.5%) participants were pure vegetarians, 7 (0.7%) were eggetarians, and 378 (37.8%) consumed all kinds of food. 281 (28.1%) participants had in the past or at present were having addiction, among which 278 used product containing tobacco and 15 told of consuming alcohol. 352 (35.2%) participants informed of having stress in their life. On asking history of present/past noncommunicable diseases (NCDs), 489 (48.9%) participants had positive history of any NCDs. Total 206 participants were suffering from hypertension, 114 had diabetes, while 100 individuals had both hypertension and diabetes. Among total, 69 participants were suffering from other health-related conditions with or without having diabetes and/or hypertension. Other category includes diseases such as hypothyroidism, migraine, dyslipidemia, cardiovascular disease, cerebrovascular accident, and asthma.

From all of the participants, 344 (34.4%) participants had heard of 'cholesterol', among them 327 (95.1%) knew about its relation to health, out of which 323 (98.8%) knew that above normal limit of cholesterol is harmful.

The belief about some effect of alternatively changing variety of oil on health was existed among 122 participants. Out of them, 56 believed that it was harmful while 66 believed that it was helpful for health. The most commonly used cooking oil was cottonseed (56.2%), followed by groundnut (25.1%), sunflower or safflower (9.3%), and soybean (2.5%). Other oils such as mustard, corn, sesame, rice bran, palmolein, and coconut were used by only 4% of participants. Out of total, 29 (2.9%) participants practiced changing of cooking oil. Method of changing cooking oil was alternate in 15 (51.7%) participants. The found determinants for changing oil were according to the type of food being prepared and type of oil available from nearby shop in 8 (27.6%) and 6 (20.7%) participants, respectively.

A total of 971 participants informed that they did not change the type of cooking oil since many years. Various reasons given by participants for not changing oil were lack of knowledge that oil should be changed in 520 (53.6%), economical constraint to buy other costly oils in 402 (41.4%), family head does not allow changing of oil in 25 (2.6%), spouse does not allow in 10 (1.0%), belief of “there is no health benefit by changing oil” in 6 (0.6%), family members do not like taste of food if oil is changed in 5 (0.5%), and a belief “oil changing is dangerous for health” in 3 (0.3%) participants.

Out of total, 493 participants used to repeatedly heat the same oil for frying. Of these participants, 181 informed that there is some effect of repeated using the same oil for frying on health, of which 169 (93.3%) believed that it had harmful effect and 12 (6.7%) believed that it had helpful effect on health.

On assessing the association between type of cooking oil (2 variables: only one type used and changing variety of cooking oil used) and cholesterol-HDL ratio (3 variables: optimal, moderate risk, and high risk), it was revealed the contingency coefficient value of 0.042 with P = 0.416. Hence, no statistical association was obtained between changing variety of cooking oil and cholesterol-HDL ratio.

Statistical association was obtained between BMI and cholesterol level. As BMI increases, cholesterol level also increased. Statistical association was also obtained between BMI and cholesterol-HDL ratio. As BMI increases, cholesterol-HDL ratio also increased. Statistical association was obtained between type of cooking oil used and BMI [Table 4].
Table 4: Association of body mass index with other risk factors of cardiac diseases

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No statistical association was obtained between type of cooking oil used and cholesterol-HDL ratio (Fisher's exact value = 11.510; P value = 0.319).

On performing Multivariate analysis between BMI, Lipid profile and type of cooking oil used, No statistical significance was found [Table 5].
Table 5: Multivariate analysis between body mass index, lipid profile, and type of cooking oil used

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Statistical association was obtained between raised blood pressure and cholesterol-HDL ratio (contingency coefficient value = 0.094; P value = 0.012). Cholesterol-HDL ratio was poor in participants who had raised blood pressure. Similarly, statistical association was obtained between raised blood sugar and cholesterol-HDL ratio (contingency coefficient value = 0.214; P ≤ 0.001). Cholesterol-HDL ratio was poor in participants who had raised blood sugar.


  Discussion Top


Majority of participants had normal level of serum cholesterol (72.6%) and normal level of serum HDL (68.2%), but serum cholesterol-HDL ratio was optimum in only 43.4% of participants. Hence, it supports the conclusion of various studies that cholesterol-HDL ratio is a more sensitive indicator compared to other indicators.[15],[16]

Majority of participants were overweight-obese based on various obesity indices such as BMI (72.9%), Lorentz (78.0%), Broca's (69.0%), and Ponderal index (76.4%). However, according to Corpulence index, only 38.5% were having more than normal weight. More than half (57.5%) the number of participants had more than normal waist–hip ratio.

Most participants used cottonseed oil (56.2%) for cooking, followed by groundnut (25.1%), sunflower or safflower (9.3%), and others. Only 2.9% of participants consumed combination of oil. Alternatively changing variety of oil (51.7%) was most preferred method by participants. The most common reason provided by participants regarding changing the variety of cooking oil was lack of knowledge about benefits of changing the oil (53.6%), followed by economic constraints in buying other variety (41.4%).

It is common nowadays that many people suggest about changing variety of cooking oil. Many articles are published advising people about changing variety of cooking oil.[18] In a three-county collaborative study, it was found that certain variety of cooking oil significantly altered lipid profile.[19] In another study done among rats in Pakistan, it was found that different varieties of cooking oil had different effects on lipid profile of rats.[20] In a review article published, it was found that all oils had beneficial effect on health and no specific detrimental effects of oil on health were found.[21] However, in a trial done among hen, it was found that different cooking oils did not have any effect on lipid profile.[22] In the present study also, no statistical association was obtained between changing variety of cooking oils used and cholesterol level (contingency coefficient value = 0.047; P = 0.335) as well as cholesterol-HDL ratio level (contingency coefficient value = 0.042; P = 0.416). This may suggest that only changing variety of cooking oil does not affect an individual's lipid profile. It is the genetic constitution, physical exercise, stress, and other factors that would influence an individual's lipid profile. Moreover, advantages of individual oil are provided in various researches, but no specific combination that should be used is suggested.

Statistical association was obtained between variety of cooking oil and BMI (Fisher's exact = 83.015; P = 0.000). BMI was more severe in participants consuming soybean, sunflower or safflower, mustard, sesame, etc., compared to cottonseed and groundnut. This may have occurred as those participants may have recently changed type of oil used for cooking, as their previous oil consumption was not known.

An ICMR study done in India concludes a strong association between obesity, dysglycemia, and hypertension with dyslipidemia.[3] The present study also shows similar association.

Statistical association was also obtained between BMI and cholesterol level (Fisher's exact = 37.430; P = 0.000) as well as cholesterol-HDL ratio level (Fisher's exact = 49.498; P = 0.000). There was dyslipidemia more in overweight and/or obese participants compared to underweight or normal weight participants.

In a study done by Singh et al.,[23] it was found that there is an association between blood glucose and serum lipid level. Also in other study done among Asian population, it was found that diabetes is associated with dyslipidemia.[24] Another study which concluded the same association was done in Turkey.[25] In the present study, statistical association was obtained between blood glucose and serum lipid level. In the present study, statistical association was obtained between blood pressure and serum lipid level. This is in line with other studies done by Choudhury et al.[26] in Bangladesh and by Asviandri et al.[27] in Indonesia.


  Conclusion Top


The prevalence of dyslipidemia was found to be in quarter of patients having undergone serum lipid profile testing. Statistical association was not found between serum lipid profile and type of oil used for cooking. Obesity indices revealed significant statistical association with both, variety of cooking oil used, and serum lipid profile. Dyslipidemia was also found to have statistical significant association with raised blood pressure and raised blood glucose.

Limitation of the study

The association between BMI and variety of cooking oil was established in the current study but per capita amount of cooking oil used/consumed could be proved a better association with BMI rather than only type of cooking oil used. The same was not assessed in this research project.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Mathers C, Fat DM, Boerma JT; World Health Organization. The Global Burden of Disease: 2004 Update. Geneva: World Health Organization; 2008.  Back to cited text no. 1
    
2.
Sample Registration System. Million Death Study: Preliminary Report on Causes of Death in India 2001–2003. New Delhi: Registrar General of India; 2007.  Back to cited text no. 2
    
3.
Joshi SR, Anjana RM, Deepa M, Pradeepa R, Bhansali A, Dhandania VK, et al. Prevalence of dyslipidemia in urban and rural India: The ICMR-INDIAB study. PLoS One 2014;9:e96808.  Back to cited text no. 3
    
4.
Shepherd J, Cobbe SM, Ford I, Isles CG, Lorimer AR, MacFarlane PW, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. Engl J Med 1995;333:1301-7.  Back to cited text no. 4
    
5.
Luscombe-Marsh ND, Noakes M, Wittert GA, Keogh JB, Foster P, Clifton PM. Carbohydrate-restricted diets high in either monounsaturated fat or protein are equally effective at promoting fat loss and improving blood lipids. Am J Clin Nutr 2005;81:762-72.  Back to cited text no. 5
    
6.
Howard BV, Horn LV, Hsia J, Manson JA, Stefanick ML, Wassertheil-Smoller S, et al. Low-fat dietary pattern and risk of cardiovascular disease: The Women's Health Initiative Randomized Controlled Dietary Modification Trial. JAMA 2006;295:655-66. Available from: http://search.ebscohost.com/login.aspx?direct=trueanddb=cghandAN=CN-00555064andsite=ehost-live. [Last accessed on 2019 Jun 05].  Back to cited text no. 6
    
7.
Frood S, Johnston LM, Matteson CL, Finegood DT. Obesity, complexity, and the role of the health system. Curr Obest Rep 2013;2:320-6. Available from: http://link.springer.com/10.1007/s13679-013-0072-9. [Last accessed on 2019 Jun 05].  Back to cited text no. 7
    
8.
Tarentino AL, Maley F. A comparison of the substrate specificities of endo-beta-N-acetylglucosaminidases from Streptomyces griseus and Diplococcus pneumoniae. Biochem Biophys Res Commun 1975;67:455-62.  Back to cited text no. 8
    
9.
Ferrier DR, Harvey RA. Lippincott's Illustrated Reviews: Biochemistry. 6th ed. Philadelphia: Wolters Kluwer/ Lippincott Williams and Wilkins; 2014. p. 361-64. Available from: https://ia600106.us.archive.org/6/items/LippincottsIllustratedReviews Biochemistry6EPDFtahir99VRG_201802/ Lippincott%27s%20Illustrated%20Reviews%20Biochemistry%2C%206E%20%5BPDF%5D%5Btahir99%5D%20VRG.pdf. [Last accessed on: 2018 September 10].  Back to cited text no. 9
    
10.
Hu FB, Manson JE, Willett WC. Types of dietary fat and risk of coronary heart disease: A critical review. Am Coll Nutr 2001;20:5-19. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11293467. [Last accessed on 2018 Sep 05].  Back to cited text no. 10
    
11.
Burtis CA, Ashwood ER, Burns DE, editors. Tietz Textbook of Clinical Chemistry and Molecular Diagnosis. 5th ed. St. Louis, USA: Elsevier; 2012. p. 952.  Back to cited text no. 11
    
12.
Park K. Park's Textbook of Preventive and Social Medicine. 24th ed. Jabalpur, M.P., India: Bhanot Publishers; 2017. p. 789-94.  Back to cited text no. 12
    
13.
Ponderal Index Calculator. Available from: http://elsenaju.eu/Calculator/Ponderal-Calculator.html. [Last accessed on 2018 Aug 20].  Back to cited text no. 13
    
14.
Ministry of Health and Family Welfare. Hypertension: Background document. Screening, Diagnosis, Assessment and Management of Primary Hypertension in Adults in India. Ministry of Health and Family Welfare, Government of India; March, 2016.  Back to cited text no. 14
    
15.
Couillard C, Bergeron N, Prud'homme D, Bergeron J, Tremblay A, Bouchard C, et al. Postprandial triglyceride response in visceral obesity in men. Diabetes 1998;47:953-60. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9604874. [Last accessed on 2018 Sep 10].  Back to cited text no. 15
    
16.
Lemieux I, Lamarche B, Couillard C, Pascot A, Cantin B, Bergeron J, et al. Total cholesterol/HDL cholesterol ratio vs. LDL cholesterol/HDL cholesterol ratio as indices of ischemic heart disease risk in men: The Quebec Cardiovascular Study. Arch Intern Med 2001;161:2685-92.  Back to cited text no. 16
    
17.
Consumer Price Index Numbers for Industrial Workers Base 2001=100. Available from: http://labourbureaunew.gov.in/All_India_gp_subgp_indices_June_2018.pdf. [Last accessed on 2019 Jun 15].  Back to cited text no. 17
    
18.
Live Your Life More: Why You Should Change Your Cooking Oil Every 2-3 Months. Available from: http://www.liveyourlifemore.com/change-cooking-oil-every-2-3-months/. [Last accessed on 2018 Sep 09].  Back to cited text no. 18
    
19.
Sales RL, Coelho SB, Costa NMB, Bressan J, Iyer S, Boateng LA, et al. The effects of peanut oil on lipid profile of normolipidemic adults: A three-country collaborative study. J Applied Res 2008;8:216-25.  Back to cited text no. 19
    
20.
Shad MA, Iqbal T, Shah MH, Khalid Mahmood MT. Vegetable oils and dyslipidemia. Pak J Med Sci 2003;19:45-51.  Back to cited text no. 20
    
21.
Bester D, Esterhuyse AJ, Truter EJ, Van Rooyen J. Cardiovascular effects of edible oils: A comparison between four popular edible oils. Nutr Res Rev 2018;23:334-48.  Back to cited text no. 21
    
22.
Murata L, Ariki J, Machado C, Silva L da P da, Rezende M. Effect of oils sources on blood lipid parameters of commercial laying hens. Rev Bras Ciência Avícola 2003;5:203-6. Available from: http://www.scielo.br/scielo.php?script=sci_arttextandpid=S1516-635X2003000300008andlng=enandnrm=isoandtlng=en. [Last accessed on 2019 Jun 06].  Back to cited text no. 22
    
23.
Singh O, Gupta M, Khajuria V. Lipid profile and its relationship with blood glucose levels in metabolic syndrome. Natl J Physiol Pharm Pharmacol 2015;5:134-7.  Back to cited text no. 23
    
24.
Zhang L, Qiao Q, Tuomilehto J, Hammar N, Janus ED, Söderberg S, et al. The effects of peanut oil on lipid profile of normolipidemic adults: A three-country collaborative study. J App Res 2008;8:216-25.  Back to cited text no. 24
    
25.
Ozder A. Lipid profile abnormalities seen in T2DM patients in primary healthcare in Turkey: A cross-sectional study. Lipids Health Dis 2014;13:183.  Back to cited text no. 25
    
26.
Choudhury KN, Mainuddin AK, Wahiduzzaman M, Islam SM. Serum lipid profile and its association with hypertension in Bangladesh. Vasc Health Risk Manag 2014;10:327-32.  Back to cited text no. 26
    
27.
Lita F, Eka R, Rahmi L, Susetyo C, Febrianti ES. Association between lipid profile and blood pressure in obese adolescents in Padang. Int J Pediatr Endocrinol 2013;2013:P88. 10.1186/1687-9856-2013-S1-P88.  Back to cited text no. 27
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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