The Association Between Dietary Acidity and Clinical Symptoms in Patients With Rheumatoid Arthritis.

This study aimed to investigate the relationship between dietary acidity load and clinical symptoms in the patients with rheumatoid arthritis (RA). This case-control study examined 55 patients with RA and 215 healthy individuals in a Ravansar non-communicable diseases (RaNCDs) cohort study, Iran. Participants' food intakes were assessed using a validated food frequency questionnaire. The dietary acidity was calculated using potential renal acid load (PRAL), net endogenous acid production (NEAP), and dietary acid load (DAL) scores. The patients with RA were identified based on the self-reporting, medications history, and the approval of the cohort center physician following patients' examination. The odds ratio (OR) of joint stiffness in fully adjusted model was greater in the upper median of dietary acidity than in the lower median (PRAL: odds ratio [OR], 1.18; 95% confidence interval [CI], 0.59-2.36), but there was no statistically significant difference. The OR of joint pain in the upper median of dietary acidity was less than in the lower median in fully adjusted model (PRAL: OR, 0.70; 95% CI, 0.46-1.29), but the difference was not statistically significant. After adjusting potential confounders, people in the upper median of dietary acidity had a higher OR of developing RA than those in the lower median (PRAL: OR, 1.39; 95% CI, 0.70-2.76); however, it was not statistically significant. There was not any statistically significant relationship among dietary acidity and the odds of joint pain, joint stiffness, and developing RA.

The relationship of dietary total antioxidant capacity with sarcopenia and cardiometabolic biomarkers in type 2 diabetes patients.

BACKGROUND: The aim of this study was to investigate the relationship of dietary total antioxidant capacity (DTAC) with sarcopenia and metabolic biomarkers in people with type 2 diabetes in the Kurdish race. METHODS: In this cross-sectional study, data of 189 type 2 diabetic patients (35-65 years old) from RaNCD cohort study were evaluated. DTAC, fasting blood sugar, lipid profile, body composition, muscle strength, and sarcopenia were assessed. t and χ2 tests to compare the variables between sarcopenic and non-sarcopenic patients and one-way analysis of variance to compare the variables in DTAC tertiles were used. The relationship between DTAC and different variables was evaluated using multiple logistic regression model. RESULTS: The mean age and body mass index were 49.7 ± 8.7 years and 27.1 ± 3.9 kg/m2 . Body mass index, waist circumference, and hip circumference were significantly different between diabetic patients with and without sarcopenia (p < 0.05). In crude (p = 0.010) and adjusted (p = 0.035) models, there was a significant relationship between DTAC and fasting blood sugar. Also, the relationship between DTAC with waist (p = 0.019) and hip (ß = -4.25, p = 0.026) circumference was significant. Sarcopenia was significantly lower in the third tertile in comparison with the first tertile of DTAC (p = 0.016).  CONCLUSION: Diet with higher DTAC can be associated with lower fasting blood sugar, abdominal obesity and sarcopenia in type 2 diabetic patients. However, further studies are required to confirm these relationships.

Association between deficient levels of circulating vitamin D, dietary intake of vitamin D, calcium and retinol, and risk of colorectal cancer in an Iranian population: A case control study.

AIM: We aimed to assess the association between deficient levels of circulating vitamin D, dietary intake of vitamin D, calcium and retinol, and risk of colorectal cancer in an Iranian population. METHODS: In this retrospective case-control study that was conducted between 2012 and 2015, 278 first incident colorectal cancer cases (colon cancer = 103; rectal cancer = 175), and 278 sex and age matched healthy controls (HCs) were recruited. Serum 25(OH)D, dietary vitamin D, and calcium intake were assessed. Logistic regression was used to estimate the odds ratio (OR) between studied factors and colorectal cancer. Estimates of OR were calculated according to both bivariate analyses based on the matching factors and multivariate analyses, with additional adjustment for potential confounders. RESULTS: A strong inverse linear dose-response association was seen between serum 25(OH)D and colorectal cancer (P for trend = .002). In comparison to serum 25(OH)D more than 40 nmol/L, lower serum concentrations were significantly associated with an increased OR of colorectal cancer. When analyzing anatomical subsites separately, lower circulating 25(OH)D was associated with higher OR for both colon and rectum cancers. Dietary vitamin D and calcium intake were not associated with colorectal cancer. Interaction analysis between serum 25(OH)D and the amount of calcium intake demonstrated that the lowest level of both factors was associated with an increased OR of colorectal cancer. The highest OR of colorectal cancer that was associated with lowest circulating 25(OH)D was stronger at the highest retinol intakes. CONCLUSION: This study demonstrated an inverse strong association between 25(OH)D concentration and colorectal cancer in an Iranian population.

The effect of vitamin D supplementation on flow-mediated dilatation, oxidized LDL and intracellular adhesion molecule 1 on type 2 diabetic patients with hypertension: A randomized, placebo-controlled, double-blind trial.

AIMS: Current study aimed to evaluate the effect of vitamin D supplementation on flow-mediated dilatation (FMD), oxidized LDL (oxLDL) and intracellular adhesion molecule 1 (ICAM1) in type 2 diabetic patients with hypertension. METHODS: In a double-blinded, placebo-controlled trial, 44 patients were randomly divided into vitamin D group (2000 IU/d, n = 23) and placebo group (control, n = 21) for 12 weeks. Vascular function with FMD, Serum 25-OH vitamin D, oxLDL and ICAM1 were assessed at the baseline and after the intervention. This clinical trial was registered at Iranian Registry of Clinical Trials (IRCT20191223045861N1). RESULTS: In intervention group serum level of vitamin D increased from 32.42 ± 10.56 to 40.45 ± 12.94 (p < 0.001). In the vitamin D group, oxLDL and ICAM1 significantly decreased and FMD increased significantly in both groups (p < 0.001). The level of oxLDL (p = 0.017) and ICAM1 (p < 0.001) were significantly lower in the vitamin D group than the placebo group and FMD (p < 0.001) was significantly higher in the vitamin D group. CONCLUSIONS: Vitamin D supplementation of 2000 IU/d for 12 weeks can improve endothelial function and decrease ICAM1 and oxLDL in type 2 diabetic patients with hypertension.

The effects of vitamin D and curcuminoids supplementation on anthropometric measurements and blood pressure in type 2 diabetic patients with coexisting hypovitaminosis D: A double-blind, placebo-controlled randomized clinical trial.

BACKGROUND AND AIMS: Curcuminoids and vitamin D have been shown to improve blood pressure and body weight in diabetic animals; however, consistent findings in type 2 diabetes mellitus (T2DM) patients are limited. This study was performed to evaluate the effects of curcuminoids and vitamin D, simultaneously or singly on anthropometric measurements and blood pressure in T2DM patients with insufficient vitamin D level. METHODS: In this randomized, placebo-controlled clinical trial, eighty T2DM patients were randomly assigned into 4 groups receiving (1) 500 mg/day curcuminoids; (2) 50,000 IU/week vitamin D3; (3) 50,000 IU/week vitamin D3 plus 500 mg/d curcuminoids; or (4) placebos for 12 weeks. Blood pressure and anthropometric measurements were evaluated before and after intervention. RESULTS: Intergroup comparisons showed that Vitamin D (main effect) significantly reduced systolic blood pressure (SBP) and diastolic blood pressure (DBP) (P = 0/000). Curcuminoids (main effect) significantly reduced DBP (P = 0/001). Interaction effects showed that curcuminoids significantly prevented the effect of vitamin D on the reduction of SBP (P = 0.006). Whereas, vitamin D and curcuminoids had a synergistic effect on DBP reduction (P = 0.006). The comparison of changes in anthropometric measurements between the four groups showed no significant differences in the raw and adjusted models. In-group comparisons showed that SBP, DBP, waist to hip circumference (WHR), body fat mass (BFM), percent body fat (PBF) and visceral fat area (VFA) values were significantly reduced in all groups except the placebo group compared to baseline values. Only in the CR-D group, there was a significant reduction in body weight (P = 0/047). CONCLUSIONS: Curcuminoids and vitamin D may have beneficial effects on blood pressure and anthropometric measurements in T2DM patients. CLINICAL REGISTRATION: http://www.IRCT.ir:IRCT2017041213678N22.

Efficacy of a Short-Term Low-Calorie Diet in Overweight and Obese Patients with Chronic Sciatica: A Randomized Controlled Trial.

Objectives: Chronic sciatica is a common condition. According to Traditional Persian Medicine and recent studies, calorie reduction is thought to be helpful for this condition. The purpose of this work is to evaluate a short-term low-calorie diet (LCD) for ameliorating chronic sciatica in the context of pain relief and reduced disability for patients. Design: In this randomized controlled trial, 96 candidates for the nonsurgical treatment of chronic sciatica were randomly assigned to two groups to receive a 1-month LCD (intervention) or ordinary diet (control), both in combination with nonsteroidal anti-inflammatory drugs (NSAIDs). Afterward, patients were visited at baseline and on days 15, 30, and 60 after treatment. Pain and disability were evaluated using the short-form McGill pain questionnaire (SFMPQ) and the Roland-Morris disability questionnaire (RMDQ), respectively. Results: Both mean RMDQ scores and SFMPQ scores decreased significantly in the LCD group compared to the control group. SFMPQ descriptor scale scores at baseline and on days 15, 30, and 60 in the LCD group were 7.71 ± 1.69, 6.63 ± 1.61, 5.54 ± 1.87, and 4.96 ± 2.02, respectively, and in the control group were 6.63 ± 1.44, 6.69 ± 1.32, 6.64 ± 1.98, and 6.62 ± 2.53, respectively (p = 0.001). RMDQ scores at baseline and on days 15, 30, and 60 in LCD group were 11.17 ± 3.90, 8.60 ± 1.97, 7.50 ± 2.71, and 6.77 ± 3.06, respectively, and in the control group, 10.00 ± 2.20, 9.98 ± 2.29, 9.94 ± 2.94, and 9.85 ± 3.32, respectively (p < 0.001). Conclusion: A short-term (1-month) LCD is effective in decreasing pain and disability in candidates for nonsurgical treatment of chronic sciatica.

An Empirical Study on the Effect of Short-Term Regular Vitamin D3 Supplement Therapy on Blood Pressure and Exercise Tolerance in Heart Failure Patients.

The receptor of vitamin D is expressed in almost all body cells, including vascular endothelial cells and cardiomyocytes. Vitamin D deficiency has been observed widespread amongst heart failure (HF) patients, which could have harmful effects on their health condition. This study aims to investigate the effect of vitamin D supplements on blood pressure (BP) and physical activity of HF patients. Thirty-nine systolic HF patients with low ejection fraction (EF) < 50% and class III of New York Heart Association functional classification were randomly divided into 2 groups including intervention and placebo to enroll in an 8 weeks double-blind clinical trial. During the trial 6-minute walk test (6MWT), 25-hydroxyvitamin D (25[OH]D) level, BP, sodium and potassium intakes were assessed. The mean 25(OH)D level increased to 28.9 ± 11.7 ng/mL (p < 0.001) in the intervention group. There was a poor but non-significant reduction in systolic BP (-0.033 ± 4.71 mmHg, p = 0.531) in the intervention group. The BP also did not change in the placebo group at the end of the trial. A negligible decrease of 6MWT was observed in the intervention group (-6.6 ± 29.2 m) compared to the placebo (-14.1 ± 40.5 m). However, differences between the 2 groups were not statistically significant (p = 0.325). The results solely showed a slight positive correlation between 25(OH)D level and 6MWT. No significant improvements in BP and 6MWT were observed after vitamin D3 supplementation. TRIAL REGISTRATION: Iranian Registry of Clinical Trials Identifier: IRCT2016102113678N13.

A review of synbiotic efficacy in non-alcoholic fatty liver disease as a therapeutic approach.

According to recent epidemiological studies, non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the worldwide. Pathophysiological pathways and mechanisms involved in NAFLD are not fully clear, but Inflammation, insulin resistance, oxidative stress, obesity and dyslipidemia are among the main causes of NAFLD. There is still no standard drug for the treatment of NAFLD. Diet modification, weight loss and physical activity are considered as the main treatment line for this disease. It has been shown that gut microbiota imbalance is associated with the main factors causing of NAFLD. Synbiotics, which have positive effects on the balance of gut microbiota, are a combination of prebiotics and probiotics. It is believed that the consumption of synbiotics can help to treatment of NAFLD through effect on gut microbiota and subsequently improving the risk factors of this disease. The purpose of this review is to investigate the effects of synbiotics on the main causes of NAFLD based on existing evidence, especially the clinical effects of synbiotics supplementation in patients with NAFLD.

The Effect of Conjugated Linoleic Acid Supplementation on Body Composition, Serum Insulin and Leptin in Obese Adults.

BACKGROUND: Studies have reported contradictory findings regarding the effect of a mixture of 2 conjugated linoleic acid (CLA) isomers on body weight and some serum indices. This study aims to investigate the effect of daily supplementation of these 2 isomers on body composition and serum leptin and insulin levels in obese adults. METHODS: This randomized, double-blind clinical trial was performed on 54 adults with class I obesity. The subjects were randomly assigned into 2 groups of 27 and were followed for 3 months so that a total of 3000 mg of CLA supplement and placebo were administered in 3 daily doses in the intervention and control groups, respectively. Body composition indices as well as fasting serum levels of insulin and leptin were also measured. The paired t-test was used for evaluating within-group effects from baseline. The independent t-test was used to compare between-group differences for variables with normal distribution. RESULTS: Although body weight and body mass index (BMI) were not significantly decreased during intervention in groups, but the body fat mass (BFM) (P=0.034), body fat percentage (P=0.022) and trunk fat (P=0.027) decreased significantly during intervention with CLA. The fasting plasma sugar (P=0.042) and Homeostatic model assessment for insulin resistance (HOMA/IR) (P=0.044) in the intervention group declined during 12 weeks of intervention. Serum leptin was associated with a significant decrease during the intervention period (P=0.039). CONCLUSION: CLA supplementation could reduce body fat and serum leptin. Hence, it could be taken into account as a factor for weight loss but not to control or prevent diabetes.

A narrative review on effects of vitamin D on main risk factors and severity of Non-Alcoholic Fatty Liver Disease.

The global prevalence of Non-alcoholic fatty liver disease (NAFLD) is increasing rapidly. Many studies have been conducted on the treatment of NAFLD; nevertheless, there is still no approved drug treatment for this disease. Although the pathogenesis of NAFLD is not fully understood, but inflammation, insulin resistance, oxidative stress, obesity and dyslipidemia are among the main causes. Epidemiological studies have shown that hypovitaminosis D is associated with these factors causing NAFLD. In addition, rate of Vitamin D deficiency has been shown to be directly related to the severity of NAFLD. Accordingly, it is believed that vitamin D may help to treatment of NAFLD by improving the above-mentioned risk factors. The purpose of this review is to survey the recent advances in the field of Vitamin D efficacy on risk factors and the severity of NAFLD based on existing evidence, especially the clinical efficiency of vitamin D supplementation in patients with NAFLD.

Curcumin and Gastric Cancer: a Review on Mechanisms of Action.

BACKGROUND AND AIM: Gastric cancer, as the fourth cause of death in women and third in men with malignant tumors, is now threatening people's lives worldwide. Natural anti-tumor products are potential anti-cancer agents with fewer by-effects. Curcumin, an herbal product, has been used as a cosmetic and food additive and as a traditional herbal medicine for thousands of years in Asian countries. Several studies revealed that curcumin can inhibit the invasion and proliferation of gastric cancer cells. This paper analyzes existing data from animal and in vitro studies in order to highlight the mechanisms of therapeutic effects of curcumin in gastric cancer. METHODS: Science Direct and Pub Med databases were searched by using "curcumin" and "gastric cancer" for searching the studies aiming the application of curcumin and the beneficial effects of curcumin in gastric cancer control and treatment. RESULTS: These results suggested that curcumin can suppress multiple signaling pathways and inhibit cancer cell proliferation, invasion, metastasis, and angiogenesis. According to the studies, curcumin can inhibit gastric cancer by several mechanisms including decreasing proliferation, inducing apoptosis, and reducing chemo-resistance in gastric cancer cells. CONCLUSIONS: The findings of present paper provided novel perceptions about the mechanisms of curcumin action in gastric cancer cell growth inhibition and its therapeutic strategies for gastric cancer control. So, curcumin could be considered as a novel therapeutic strategy to control gastric cancer cell growth.

Role of vitamin D deficiency in systemic lupus erythematosus incidence and aggravation.

Vitamin D is one of the main groups of sterols; playing an important role in phospho-calcic metabolism. The conversion of 7-dehydrocholesterol to pre- vitamin D3 in the skin, through solar ultraviolet B radiation, is the main source of vitamin D. Since lupus patients are usually photosensitive, the risk of developing vitamin D deficiency in is high in this population. Although evidences showed the connotation between systemic lupus erythematosus (SLE) and vitamin D through which SLE can lead to lower vitamin D levels, it is also important to consider the possibility that vitamin D deficiency may have a causative role in SLE etiology. This paper analyzes existing data from various studies to highlight the role of vitamin D deficiency in SLE occurrence and aggravation and the probable efficacy of vitamin D supplementation on SLE patients. We searched "Science Direct" and "Pub Med" using "Vitamin D" and "SLE" for finding the studies focusing on the association between vitamin D deficiency and SLE incidence and consequences. Evidences show that vitamin D plays an important role in the pathogenesis and progression of SLE and vitamin D supplementation seems to ameliorate inflammatory and hemostatic markers; so, can improve clinical subsequent.

General and Central Obesity in Two Iranian Ethnic Groups Living in Urmia, West Azerbaijan, Iran: Effect of the Neighborhood Environment.

BACKGROUND: Emerging evidence suggests that neighborhood characteristics can have direct and indirect effects on the weight status of the residents. OBJECTIVES: To assess the relationship between general and central obesity and the neighborhood environment in two ethnic groups (Azeri Turks and Kurds) living in Urmia city, Northwestern Iran. PATIENTS AND METHODS: In this cross-sectional study, 723 participants (427 women and 296 men) aged 20 - 64 years from two ethnic groups (Azeri Turks, n = 445; Kurds, n = 278) were selected from 38 neighborhoods using a combination of cluster, random, and systematic sampling methods. Neighborhood characteristics were obtained by a validated 22-item neighborhood and a health observational checklist. General and central obesity were measured and evaluated using standard methods. Principal component analysis (PCA) was used to define the dominant neighborhood environment. The association of neighborhood characteristics with general and central obesity was analyzed by a logistic regression model. RESULTS: Three common neighborhood environments were identified: 1) modern-affluent, 2) central-high access and 3) marginal. These three factors explained 73.2% of the total variance. Overall, the participants living in a higher tertile of the central-high access neighborhoods had an increased chance of central obesity (OR = 1.63, 95% CI: 1.13 - 2.34). Azeri Turks living in the highest tertile of the modern-affluent neighborhoods had a significantly higher likelihood of having general obesity (OR = 2.49, 95% CI: 1.37 - 4.01). Adjustment for age, gender, marital status, socioeconomic status (SES), energy intake, and physical activity did not change the results. However, after adjustment for educational level, the association was not significant. CONCLUSIONS: The findings point to a relationship between neighborhood characteristics and obesity only in the Azeri Turks. However, educational level was more important than neighborhood quality in predicting the risk of obesity.

Major dietary patterns in relation to demographic and socio-economic status and food insecurity in two Iranian ethnic groups living in Urmia, Iran.

OBJECTIVE: To identify major dietary patterns and their association with socio-economic status (SES) and food insecurity in two major ethnic groups living in Urmia, north-west Iran. DESIGN: A cross-sectional study. SETTING: All four geographical zones of Urmia city. SUBJECTS: Participants (n 723; 427 women and 296 men), aged 20-64 years, from two ethnic groups (445 Azeri Turks and 278 Kurds). RESULTS: Three major dietary patterns were extracted: 'Traditional High SES' (THS), 'Traditional Low SES' (TLS) and 'Transitional'. After adjusting for confounders, the THS pattern was positively associated with education level and negatively associated with moderate or severe food insecurity in Azeri Turks; whereas, among Kurds, it was more common in women and positively associated with age. The TLS pattern was more common among men and negatively associated with educational level and all levels of food insecurity in Azeris; while, among Kurds, it was more common among men, positively associated with being married and negatively associated with household income/capita. The 'Transitional' pattern was positively associated with being employed and negatively associated with age and all levels of food insecurity in Azeris; while, among Kurds, it was more common among men and negatively associated with age, being married and physical activity level. CONCLUSIONS: Findings suggest that household SES and food insecurity are associated with detrimental dietary patterns and that this effect may be stronger than cultural and ethnic background. These patterns differ by age and gender. Therefore, such characteristics should be considered in planning and formulating diet-related policies and programmes.

Food insecurity, socio-economic factors and weight status in two Iranian ethnic groups.

OBJECTIVE: To study the association of weight status with food insecurity (FI) and socio-economic status (SES) in Azeri and Kurd ethnic groups living in Urmia city, North-Western Iran. DESIGN: In this cross-sectional study, 723 participants (427 women and 296 men) aged 20-64 years old, from two ethnic groups (445 Azeri and 278 Kurd), were selected through a combination of cluster, random and systematic sampling methods. Demographic and socio-economic characteristics were assessed by a valid questionnaire, and household food security status was analyzed using an adapted household food insecurity access scale through face-to-face interviews at homes. General and central obesities were measured and evaluated using standard methods. RESULTS: Based on the findings, moderate-to-severe FI, as well as low SES, was more dominant in Kurds, compared to Azeris. After adjusting for confounders, being female (OR = 4.33, CI 95%: 2.35-7.97) and moderate-to-severe FI (OR = 2.00, CI 95%: 1.01-3.97) in Azeris and being female (OR = 5.39, CI 95%: 2.28-12.23) and higher total cost of household/capita (OR = 1.005, CI 95%: 1.002-1.009) in Kurds were related to higher odds of general obesity while low (OR = 0.41, CI 95%: 0.18-0.91) and moderate (OR = 0.13, CI 95%: 0.02-0.60) education levels were linked to lower chance of general obesity. Furthermore, the chance of central obesity was lower in Azeris with high educational levels (OR = 0.64, CI 95%: 0.21-0.94), females (OR = 0.72, CI 95%: 0.34-0.86), home owners (OR = 0.56, CI 95%: 0.31-0.91) and females Kurds (OR = 0.60, CI 95%: 0.37-0.97) with moderate-to-severe FI and higher total income per capita. In contrast, the chance of central obesity increased in Kurds with increased age (OR = 1.06, CI 95%: 1.02-1.10) and total cost of household per capita (OR = 1.004, CI 95%: 1.000-1.008). CONCLUSION: These findings show that the association between moderate-to-severe FI and risk of general/central obesity varies in Azeris, compared to Kurds. However, better SES decreased the chance of general/central obesity in both ethnic groups.

The Effect of Vitamin D Supplementation on Adiposity, Blood Glycated Hemoglobin, Serum Leptin and Tumor Necrosis Factor-α in Type 2 Diabetic Patients.

BACKGROUND: Since tumor necrosis factor-α (TNF-α) could be one of the risk factors at the development of diabetes complications; as well as serum leptin deficiency is related to increased susceptibility to infections in diabetic patients, they are potential indices from the preventive medicine viewpoint. This study was conducted to represent the effect of supplemental vitamin D3 on serum leptin, TNF-α and adiposity in type 2 diabetic patients. METHODS: In this randomized double-blind placebo-controlled trial, study sample was selected through type 2 diabetic patients (n = 51). A total of 26 patients were orally supplemented by vitamin D3 (400 IU/d) (vitamin D group) and 25 patients by placebo (placebo group) for 14 weeks. The blood glycated hemoglobin (HbA1c) and the serum ionized Ca, leptin, TNF-α, and serum 25-hydroxyvitamin D (25[OH] D) were measured at the two groups in the baseline and postintervention stages. RESULTS: It was shown that despite of theplacebo group, serum 25(OH) D and serum leptin was significantly increased (P = 0.001 and P = 0.002, respectively), while serum TNF-α was decreased significantly (P = 0.001) in vitamin D group. The remaining parameters, including body fat mass and HbA1c had no alterations between baseline and postintervention stages in vitamin D group. CONCLUSIONS: This study may advocate vitamin D supplementation among type 2 diabetic patients due to its beneficial effects on prevention of diabetes complications.

TV viewing, independent of physical activity and obesogenic foods, increases overweight and obesity in adolescents.

The aim of this study was to estimate the prevalence of overweight and obesity (OAO) and associated risk factors in a representative sample of students aged 11-20 years in Urmia, Iran. In this population-based cross-sectional study, a multistage random cluster-sampling method was used, through which 2,498 students were selected. OAO were defined based on criteria set by the US Center for Health Statistics in collaboration with the US Center for Chronic Disease Prevention and Health Promotion under the Centers for Disease Control and Prevention (CDC). OAO risk factors were assessed using a questionnaire containing questions about TV viewing, nutrition, physical activities (PA), social and economic factors. Contents of the questionnaire were validated by calculating the content validity ratio (CVR) and content validity index (CVI), based on the responses elicited from 15 experts. Reliability of the questionnaire was obtained from a test and re-test of the questionnaire completed by 15 students. To analyze the data, x2-test, t-test, and multiple logistic regression analysis were conducted. The prevalence of OAO was found to be 14.1% among the 11-20 years old students of junior and senior high schools. The results of multiple logistic regression analysis indicated that the educational level of mothers, type of school, and the time spent on viewing TV were associated with an increased risk of OAO while obesogenic foods and PA had no effect on the frequency of OAO [Odds ratio (OR) for the time spent on watching TV one hour more than usual equals 1.27 at p=0.001]. The direct correlation between TV viewing and OAO, which is independent of PA and obesogenic foods, needs to be carefully investigated through randomized clinical trials and cohort studies.