***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The federal menu labeling law will require chain restaurants to post caloric information on menus , but the impact of labeling is uncertain . PURPOSE The goal of the current study was to examine the effect of menu labeling on calories purchased , and secondarily , to assess self-reported awareness and use of labels . DESIGN Single-community pre-post-post cross-sectional study . Data were collected in 2008 - 2010 and analyzed in 2011 - 2012 . SETTING / PARTICIPANTS 50 sites from 10 chain restaurants in King County , Washington , selected through stratified , two-stage cluster r and om sampling . A total of 7325 customers participated . Eligibility criteria were : being an English speaker , aged ≥ 14 years , and having an itemized receipt . The study population was 59 % male , 76 % white non-Hispanic , and 53 % aged<40 years . INTERVENTION A regulation requiring chain restaurants to post calorie information on menus or menu boards was implemented . MAIN OUTCOME MEASURES Mean number of calories purchased . RESULTS No significant changes occurred between baseline and 4 - 6 months postregulation . Mean calories per purchase decreased from 908.5 to 870.4 at 18 months post-implementation ( 38 kcal , 95 % CI=-76.9 , 0.8 , p=0.06 ) in food chains and from 154.3 to 132.1 ( 22 kcal , 95 % CI=-35.8 , -8.5 , p=0.002 ) in coffee chains . Calories decreased in taco and coffee chains , but not in burger and s and wich establishments . They decreased more among women than men in coffee chains . Awareness of labels increased from 18.8 % to 61.7 % in food chains and from 4.4 % to 30.0 % in coffee chains ( both p<0.001 ) . Among customers seeing calorie information , the proportion using it ( about one third ) did not change substantially over time . After implementation , food chain customers using information purchased on average fewer calories compared to those seeing but not using ( difference=143.2 kcal , p<0.001 ) and those not seeing ( difference=135.5 kcal , p<0.001 ) such information . CONCLUSIONS Mean calories per purchase decreased 18 months after implementation of menu labeling in some restaurant chains and among women but not men Increased visibility of food labels is a potential method to reduce the rate of obesity . However , few empirical studies have investigated the impact of nutrition labeling on food selection or energy intake . This study tested the hypothesis that nutrition labeling in combination with nutrition label education would promote reductions in energy intake using a laboratory-based paradigm . Forty-seven male ( n=24 ) and female ( n=23 ) participants visited the Nutrition and Health Research Laboratory for a single lunch session during the months of May through August 2009 . Participants were r and omly assigned to one of two video groups ( Nutrition Labeling Education or Organic Food Movement ) and one of two labeling conditions ( Nutrition Labels or No Labels ) . Participants watched a short educational video and then consumed a buffet lunch . Data were analyzed using a three-way analysis of covariance with sex , video condition , and labeling group as the between-subject factors and age and race as covariates . There were main effects of sex and nutrition label condition on lunch energy intake with females consuming less than males and people with nutrition labels consuming less energy than those without , regardless of sex or video condition . Examination of energy intake from low-energy-density and high-energy-density foods showed that the nutrition labeling group consumed less energy from both low-energy-density and high-energy-density food sources . These data support the use of nutrition labels as a way to reduce energy intake Background Recent legislation has required calorie labels on restaurant menus as a means of improving Americans ’ health .  Despite the growing research in this area , no consensus has been reached on the effectiveness of menu labels . This suggests the possibility of heterogeneity in responses to caloric labels across people with different attitudes and demographics . The purpose of this study was to explore the potential relationships between caloric intake and diners ’ socio-economic characteristics and attitudes in a restaurant field experiment that systematic ally varied the caloric information printed on the menus . Methods We conducted a field experiment in a full service restaurant where patrons were r and omly assigned to one of three menu treatments which varied the amount of caloric information printed on the menus ( none , numeric , or symbolic calorie label ) . At the conclusion of their meals , diners were asked to complete a brief survey regarding their socio-economic characteristics , attitudes , and meal selection s. Using regression analysis , we estimated the number of entrée and extra calories ordered by diners as a function of demographic and attitudinal variables . Additionally , irrespective of the menu treatment to which a subject was assigned , our study identified which types of people are likely to be low- , medium- , and high-calorie diners . Results Results showed that calorie labels have the greatest impact on those who are least health conscious . Additionally , using a symbolic calorie label can further reduce the caloric intake of even the most health conscious patrons . Finally , calorie labels were more likely to influence the selection of the main entrée as opposed to supplemental items such as drinks and desserts . Conclusions If numeric calorie labels are implemented ( as currently proposed ) , they are most likely to influence consumers who are less health conscious – probably one of the key targets of this legislation . Unfortunately , numeric labels did little for those consumers who were already more knowledgeable about health and nutrition . To reach a broader group of diners , a symbolic calorie label may be preferred as it reduced caloric intake across all levels of health consciousness We surveyed 7318 customers from 275 r and omly selected restaurants of 11 fast food chains . Participants purchased a mean of 827 calories , with 34 % purchasing 1000 calories or more . Unlike other chains , Subway posted calorie information at point of purchase and its patrons more often reported seeing calorie information than patrons of other chains ( 32 % vs 4 % ; P<.001 ) ; Subway patrons who saw calorie information purchased 52 fewer calories than did other Subway patrons ( P<.01 ) . Fast-food chains should display calorie information prominently at point of purchase , where it can be seen and used to inform purchases Objective To assess the impact of  fast food restaurants  adding calorie labelling to menu items on the energy content of individual purchases . Design Cross sectional surveys in spring 2007 and spring 2009 ( one year before and nine months after full implementation of regulation requiring chain restaurants ’ menus to contain details of the energy content of all menu items ) . Setting 168 r and omly selected locations of the top 11 fast food chains in New York City during lunchtime hours . Participants 7309 adult customers interviewed in 2007 and 8489 in 2009 . Main outcome measures Energy content of individual purchases , based on customers ’ register receipts and on calorie information provided for all items in menus . Results For the full sample , mean calories purchased did not change from before to after regulation ( 828 v 846 kcal , P=0.22 ) , though a modest decrease was shown in a regression model adjusted for restaurant chain , poverty level for the store location , sex of customers , type of purchase , and inflation adjusted cost ( 847 v 827 kcal , P=0.01 ) . Three major chains , which accounted for 42 % of customers surveyed , showed significant reductions in mean energy per purchase ( McDonald ’s 829 v 785 kcal , P=0.02 ; Au Bon Pain 555 v 475 kcal , P<0.001 ; KFC 927 v 868 kcal , P<0.01 ) , while mean energy content increased for one chain ( Subway 749 v 882 kcal , P<0.001 ) . In the 2009 survey , 15 % ( 1288/8489 ) of customers reported using the calorie information , and these customers purchased 106 fewer kilocalories than customers who did not see or use the calorie information ( 757 v 863 kcal , P<0.001 ) . Conclusion Although no overall decline in calories purchased was observed for the full sample , several major chains saw significant reductions . After regulation , one in six lunchtime customers used the calorie information provided , and these customers made lower calorie choices Chain restaurants will soon need to disclose calorie information on menus , but research on the impact of calorie labels on food choices is mixed . This study tested whether calorie information presented in different formats influenced calories ordered and perceived restaurant healthfulness .  Participants in an online survey were r and omly assigned to a menu with either ( 1 ) no calorie labels ( No Calories ) ; ( 2 ) calorie labels ( Calories ) ; ( 3 ) calorie labels ordered from low to high calories ( Rank-Ordered Calories ) ; or ( 4 ) calorie labels ordered from low to high calories that also had red/green circles indicating higher and lower calorie choices ( Colored Calories ) . Participants ordered items for dinner , estimated calories ordered , and rated restaurant healthfulness . Participants in the Rank-Ordered Calories condition and those in the Colored Calories condition ordered fewer calories than the No Calories group . There was no significant difference in calories ordered between the Calories and No Calories groups . Participants in each calorie label condition were significantly more accurate in estimating calories ordered compared to the No Calories group . Those in the Colored Calories group perceived the restaurant as healthier . The results suggest that presenting calorie information in the modified Rank-Ordered or Colored Calories formats may increase menu labeling effectiveness OBJECTIVES We assessed the impact of restaurant menu calorie labels on food choices and intake . METHODS Participants in a study dinner ( n=303 ) were r and omly assigned to either ( 1 ) a menu without calorie labels ( no calorie labels ) , ( 2 ) a menu with calorie labels ( calorie labels ) , or ( 3 ) a menu with calorie labels and a label stating the recommended daily caloric intake for an average adult ( calorie labels plus information ) . Food choices and intake during and after the study dinner were measured . RESULTS Participants in both calorie label conditions ordered fewer calories than those in the no calorie labels condition . When calorie label conditions were combined , that group consumed 14 % fewer calories than the no calorie labels group . Individuals in the calorie labels condition consumed more calories after the study dinner than those in both other conditions . When calories consumed during and after the study dinner were combined , participants in the calorie labels plus information group consumed an average of 250 fewer calories than those in the other groups . CONCLUSIONS Calorie labels on restaurant menus impacted food choices and intake ; adding a recommended daily caloric requirement label increased this effect , suggesting menu label legislation should require such a label . Future research should evaluate menu labeling 's impact on children 's food choices and consumption Background Although point-of-purchase calorie labeling at restaurants has been proposed as a strategy for improving consumer food choices , a limited number of studies have evaluated this approach . Likewise , little research has been conducted to evaluate the influence of value size pricing on restaurant meal choices . Methods To examine the effect of point-of-purchase calorie information and value size pricing on fast food meal choices a r and omized 2 × 2 factorial experiment was conducted in which participants  ordered a fast food meal from one of four menus that varied with respect to whether calorie information was provided and whether value size pricing was used . Study participants included 594 adolescents and adults who regularly ate at fast food restaurants . Study staff recorded the foods ordered and consumed by each participant . Participants also completed surveys to assess attitudes , beliefs and practice s related to fast food and nutrition . Results No significant differences in the energy composition of meals ordered or eaten were found between menu conditions . The average energy content of meals ordered by those r and omized to a menu that included calorie information and did not include value size pricing was 842 kcals compared with 827 kcals for those who ordered their meal from a menu that did not include calorie information but had value size pricing ( control menu ) . Results were similar in most analyses conducted stratified by factors such as age , race and education level . Conclusion Additional research is needed to better evaluate the effects of calorie labeling and value size pricing on fast food meal choices . Studies in which participants are repeatedly exposed to these factors are needed since long term exposure may be required for behavior change In a prospect i ve study of risk factors for ischemic heart disease , 792 54-yr-old men selected by year of birth ( 1913 ) and residence in Göteborg , Sweden , agreed to attend for question ing and a number of anthropometric and other  measurements  in 1967 . Thirteen and one-half years later , these baseline findings were review ed in relation to the number of men who had subsequently developed diabetes mellitus . This analysis focused on the importance of abdominal adipose tissue distribution , measured as the waistto- hip circumference ratio , as a predictor for development of diabetes . Even when the confounding effect of body mass index , as a measure of the total body fat mass , was accounted for , the waist-to-hip ratio was positively and significantly associated with the risk for diabetes . These results from a prospect i ve study strongly support previous cross-sectional findings indicating that not only the degree of obesity but also the localization of fat is a risk factor for diabetes OBJECTIVE To examine the influences of nutritional information and consumer characteristics on meal quality expectations , food selection and subsequent macronutrient intakes of consumers offered a reduced-fat option in a restaurant . DESIGN A target , full-fat ( FF ) main restaurant meal option was developed in a version substantially reduced in fat and energy ( RF ) . Restaurant patrons were r and omly placed into one of four treatment groups varying in provision 
    Output:
    
Menu labeling away-from-home did not result in change in quantity or quality , specifically for carbohydrates , total fat , saturated fat , or sodium , of calories consumed among U.S. adults