***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 Front of pack food labels or signpost labels are currently widely discussed as means to help consumers to make informed food choices . It is hoped that more informed food choices will result in an overall healthier diet . There is only limited evidence , as to which format of a food label is best understood by consumers , helps them best to differentiate between more or less healthy food and whether these changes in perceived healthiness result in changes of food choice . Methods In a r and omised experimental study in Hamburg/Germany 420 adult subjects were exposed to one of five experimental conditions : ( 1 ) a simple " healthy choice " tick , ( 2 ) a multiple traffic light label , ( 3 ) a monochrome Guideline Daily Amount ( GDA ) label , ( 4 ) a coloured GDA label and ( 5 ) a " no label " condition . In the first task they had to identify the healthier food items in 28 pair-wise comparisons of foods from different food groups . In the second task they were asked to select food portions from a range of foods to compose a one-day 's consumption . Differences between means were analysed using ANOVAs . Results Task I : Experimental conditions differed significantly in the number of correct decisions ( p < 0.001 ) . In the condition " no label " subjects had least correct decisions ( 20.2 ± 3.2 ) , in the traffic light condition most correct decisions were made ( 24.8 ± 2.4 ) . Task II : Envisaged daily food consumption did not differ significantly between the experimental conditions . Conclusion Different food label formats differ in the underst and ing of consumers . The current study shows , that German adults profit most from the multiple traffic light labels . Perceived healthiness of foods is influenced by this label format most often . Nevertheless , such changes in perceived healthiness are unlikely to influence food choice and consumption . Attempts to establish the informed consumer with the hope that informed choices will be healthier choices are unlikely to change consumer behaviour and will not result in the desired contribution to the prevention of obesity and diet related diseases 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 OBJECTIVES This study examined the effects of a school-based intervention design ed to promote the consumption of low-fat white milk at lunchtime in 6 elementary schools in an inner-city , primarily Latino neighborhood . METHODS A multifaceted intervention based on social marketing techniques was delivered at 3 r and omly selected schools . The school was the unit of assignment and analysis ; 6902 children were involved in the study . Milk selection and consumption were measured by sampling discarded milk and /or tallying milk carton disappearance at baseline , immediately postintervention , and at 3 to 4 months follow-up . RESULTS Immediately postintervention , the mean proportion of sample d milk cartons that contained low-fat milk increased in the intervention schools , from 25 % to 57 % , but remained constant at 28 % in the control schools . Differences between intervention and control schools remained significant at 3 to 4 months follow-up . The intervention was not associated with a decrease in overall milk consumption . CONCLUSIONS A school-based intervention can lead to significant increases in student consumption of low-fat milk OBJECTIVE Increasing serving sizes have been identified as contributors to the obesity epidemic . Research ers suggest that consumers are in need of cues that provide norms for the appropriate amount of food to consume . The impact of one potential cue , the provision of nutritional information for a single serving as well as the entire package ( " dual-column labels " ) versus single-serving nutritional information only ( " single-column labels " ) , was investigated on the consumption of a snack food for dieters and nondieters . DESIGN In a between-subjects experimental design , participants were provided with a snack food product and nutrition label . After the opportunity for consumption , they were provided with a survey instrument . SETTING The study took place in a classroom setting . PARTICIPANTS Undergraduate students were r and omly assigned to the single-column versus dual-column label treatment groups and were classified as dieters ( n = 45 ) or nondieters ( n = 67 ) based on self-reported dieting behavior . INTERVENTION Participants were exposed to either a single-column or dual-column nutrition label . MAIN OUTCOME MEASURES Perceptions of consumption norms ; use , importance , and underst and ing of nutrition labels ; and the actual amount consumed by each individual were measured . ANALYSIS Analysis of variance was used to analyze data from the study . RESULTS Nondieting participants , but not dieting participants , ate significantly less when exposed to the dual-column label compared to the single-column label ( P < .05 ) . Although there was a significant difference in the amount consumed by dieters and nondieters in the case of the single-column label ( P < .05 ) , the presence of a dual-column label attenuated this effect . In addition , dieters reported paying greater attention to ( P < .01 ) , better perceived the necessity of ( P < .01 ) , and had better underst and ing of ( P < .05 ) label information than nondieters . In addition , dieters considered the provided serving to be more adequate than nondieters ( P < .05 ) . IMPLICATION S FOR RESEARCH AND PRACTICE Compared to st and ard , single-column labels , dual-column nutritional labels have a greater impact on the snack food consumption of nondieters Fast-food restaurants provide a growing share of daily food intake , but little information is available in the public health literature about customer purchases . In order to establish baseline data on mean calorie intake , this study was completed in the Spring of 2007 , before calorie labeling regulations went into effect in New York City . Receipts were collected from lunchtime customers , at r and omly selected New York City fast-food chains . A supplementary survey was also administered to clarify receipt items . Calorie information was obtained through company websites and ascribed to purchases . Lunchtime purchases for 7,750 customers averaged 827 calories and were lowest for s and wich chains ( 734 calories ) ; and highest for chicken chains ( 931 calories ) . Overall , one-third of purchases were over 1,000 calories , predominantly from hamburger chains ( 39 % ) and chicken chains ( 48 % ) ; s and wich chains were the lowest , with only 20 % of purchases over 1,000 calories .  " Combination meals "  at hamburger chains accounted for 31 % of all purchases and averaged over 1,200 calories ; side orders accounted for almost one-third of these calories . Lunch meals at these fast-food chains are high in calorie content . Although calorie posting may help to raise awareness of the high calories in fast-food offerings , reducing portion sizes and changing popular combination meals to include lower calorie options could significantly reduce the average calorie content of purchases This study examined the effects of an environmental intervention promoting more non-energy-containing beverage consumption compared to sugar-sweetened soft drink consumption through vending machines in an urban college setting . Eight soft drink vending machines were r and omly selected and assigned to one of three conditions over a 9-week period : energy-content labels on non-energy-containing beverage selection panels ( intervention I ) , labels plus motivational posters ( intervention II ) , or control . The totals of all beverages sold and machine revenue were recorded at baseline ( 2 weeks ) , intervention ( 5 weeks ) , and postintervention ( 2 weeks ) periods . Use of energy-content labels and motivational posters , compared with control group , result ed in a significantly lower growth rate of sugar-sweetened beverage sales ( P<0.05 ) . Total revenue for all beverages increased during the intervention period . It is estimated that the non-energy-containing beverages combined accounted for 70.52 % of the increased revenue . Results of this study suggest that energy-content labels and motivational posters on beverage vending machines may be an effective way to influence beverage sales in prevalence and outcome of heart failure with preserved ejection fraction . N Engl J Med . 2006;355(3):251 - 259 . 4 . Fonarow GC , Stough WG , Abraham WT , et al. Characteristics , treatments , and outcomes of patients with preserved systolic function hospitalized for heart failure : a report from the OPTIMIZE-HF Registry . J Am Coll Cardiol . 2007;50 (8):768 - 777 . 5 . Yancy CW , Lopatin M , Stevenson LW , De Marco T , Fonarow GC . Clinical presentation , management , and in-hospital outcomes of patients admitted with acute decompensated heart failure with preserved systolic function : a report from the Acute Decompensated Heart Failure National Registry ( ADHERE ) Data base . J Am Coll Cardiol . 2006;47(1):76 - 84 . 6 . Ahmed A , Rich MW , Fleg JL , et al. Effects of digoxin on morbidity and mortality in diastolic heart failure : the Ancillary Digitalis Investigation Group trial . Circulation . 2006;114(5):397 - 403 . 7 . Yusuf S , Pfeffer MA , Swedberg K , et al. Effects of c and esartan in patients with chronic heart failure and preserved left-ventricular ejection fraction : the CHARMPreserved Trial . Lancet . 2003;362(9386):777 - 781 . 8 . Hogg K , McMurray J. The treatment of heart failure with preserved ejection fraction ( “ diastolic heart failure ” ) . Heart Fail Rev. 2006;11(2):141 - 146 . 9 . Judge KW , Pawitan Y , Caldwell J , Gersh BJ , Kennedy JW . Congestive heart failure symptoms in patients with preserved left ventricular systolic function : analysis of the CASS registry . J Am Coll Cardiol . 1991;18(2):377 - 382 . 10 . O’Connor CM , Gattis WA , Shaw L , Cuffe MS , Califf RM . Clinical characteristics and long-term outcomes of patients with heart failure and preserved systolic function . Am J Cardiol . 2000;86(8):863 - 867 . 11 . Philbin EF , Rocco TA Jr , Lindenmuth NW , Ulrich K , Jenkins PL . Systolic versus diastolic heart failure in community practice : clinical features , outcomes , and the use of angiotensin-converting enzyme inhibitors . Am J Med . 2000;109(8):605 - 613 . 12 . Tribouilloy C , Rusinaru D , Mahjoub H , et al. Prognosis of heart failure with preserved ejection fraction : a 5 year prospect i ve population -based study . Eur Heart J. 2008;29(3):339 - 347 . 13 . Hunt SA , Abraham WT , Chin MH , et al. ACC/AHA 2005 guideline up date for the diagnosis and management of chronic heart failure in the adult : a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines ( Writing Committee to Up date the 2001 Guidelines for the Evaluation and Management of Heart Failure ) : developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation : endorsed by the Heart Rhythm Society . Circulation . 2005;112(12):e154-e235 . 14 . ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group . Major outcomes in high-risk hypertensive patients  r and omized to angiotensinconverting enzyme inhibitor or calcium channel blocker vs diuretic : the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial ( ALLHAT ) . JAMA . 2002;288(23):2981 - 2997 . 15 . Beckett NS , Peters R , Fletcher AE , et al ; HYVET Study Group . Treatment of hypertension in patients 80 years of age or older [ published ahead of print March 31 , 2008 ] . N Engl J Med . 2008;358(18):1887 - 1898 
    Output:
    
Labeling has a positive effect on final food product consumption , in contrast with fast food restaurants .
Sensory attributes were more effective than recommendations on the labels .
Follow-up of interventions confirmed the long-term effect of the target interventions