***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 Soyfoods provide healthful options for school breakfasts and lunches that are lower in saturated fat , cholesterol , fat , and calories and can help meet dem and s for vegetarian choices . Research ers tested acceptance of soy-based options substituted for popular lunch items with a diverse student population . METHODS Research ers conducted a plate waste study in 5 middle schools in Montgomery County , Maryl and , to test the comparability of soy-based alternatives to 4 popular meat-based menu items . Initially , students ranked taste , appearance , and texture of 15 soyfoods to narrow to " hybrid " beef patties , soy-based nuggets , soy-based chicken-less slices , and soy macaroni and cheese . After the meal , trained observers r and omly tagged and collected trays with and without test items and weighed leftover entrées . Research ers used a proportional odds model to compare amounts and proportions of food consumed , and a mixed model to account for differences between schools . RESULTS Students consumed the same amount of soy-based and traditional patties , nuggets , and pasta , and less soy than regular chicken in the salad ( odds ratio 0.122 , p value < .0001 ) . Students consumed higher proportions ( p value < .05 ) of traditional chicken nuggets , beef patties , chicken slices , and pasta compared to soy-based alternative products . On average , soy-based entrées had fewer calories ; less total fat , saturated fat , and cholesterol ; and more iron , fiber , and sodium compared to traditional menu items . CONCLUSIONS This study indicates that middle school students readily consume almost equal numbers of soy-based products compared to popular school lunch items . Soyfoods provide nutritional advantages Recent changes in nutrition st and ards for the National School Lunch and School Breakfast Programs assume that modification of the nutritional serving practice s of school cafeterias will result in improved childhood nutrition in the school environment . The primary aim of this paper is to summarize the findings from two recent cluster r and omized controlled trials ( Wise Mind and LA Health ) that tested the hypothesis that modification of school cafeteria environments , including changes in nutrition st and ards , would yield beneficial changes in childhood nutrition and healthy eating in the school lunch environment . A secondary aim was to investigate the association of participant characteristics and changes in nutrition and healthy eating . A third aim was to investigate the relationships between the food intake of children and : ( 1 ) foods selected by the children and ( 2 ) food that was uneaten during the lunch meal ( plate waste ) . The studies used similar approaches for modifying the school cafeteria environment and both studies used the digital photography method to measure changes in food intake , food selection , and plate waste . Both studies reported significant improvements in childhood nutrition , and the LA Health study reported improved healthy eating , following introduction of the cafeteria modification program in comparison to baseline and /or control arms . These studies confirm the hypothesis that interventions that modify the school cafeteria environment can beneficially impact childhood nutrition Project FIT was a two-year multi-component nutrition and physical activity intervention delivered in ethnically-diverse low-income elementary schools in Gr and Rapids , MI . This paper reports effects on children ’s nutrition outcomes and process evaluation of the school component . A quasi-experimental design was utilized . 3rd , 4th and 5th- grade students ( Yr 1 baseline : N = 410 ; Yr 2 baseline : N = 405 ; age range : 7.5–12.6 years ) were measured in the fall and spring over the two-year intervention . Ordinal logistic , mixed effect models and generalized estimating equations were fitted , and the robust st and ard errors were utilized . Primary outcomes favoring the intervention students were found regarding consumption of fruits , vegetables and whole grain bread during year 2 . Process evaluation revealed that implementation of most intervention components increased during year 2 . Project FIT result ed in small but beneficial effects on consumption of fruits , vegetables , and whole grain bread in ethnically diverse low-income elementary school children BACKGROUND It is often assumed that children avoid fruit in school cafeterias because of higher relative prices and preferences for other foods . Interviews with children reveal that eating whole fresh fruit can be difficult for those with small mouths or braces . Older girls find whole fruits messy and unattractive to eat . PURPOSE To determine the effect of offering pre-sliced fruit in schools on selection and intake . DESIGN Three of six schools were assigned r and omly to serve apples in slices .  Three control schools  served apples whole . Selection , consumption , and waste of apples were measured prior to and during treatment . SETTING / PARTICIPANTS Cafeterias in six public middle schools in Wayne County NY in 2011 . Participants included all students who purchased lunch on days when data were collected . INTERVENTION Treatment schools were provided with a st and ard commercial fruit slicer , and cafeteria staff members were instructed to use it when students requested apples . Trained research ers recorded how much of each apple was consumed and how much was wasted in both control and treatment schools . MAIN OUTCOME MEASURES Daily apple sales , percentage of an apple serving consumed per student , and percentage of an apple serving wasted per student . RESULTS Data were analyzed in 2012 . Schools that used fruit slicers to pre-slice fruit increased average daily apple sales by 71 % compared to control schools ( p<0.01 ) . The percentage of students who selected apples and ate more than half increased by 73 % ( p=0.02 ) at schools that served pre-sliced fruit , and the percentage that wasted half or more decreased by 48 % ( p=0.03 ) . CONCLUSIONS Sliced fruit is more appealing to children than whole fruit because it is easier and tidier to eat . This study applies the principle of convenience from behavioral economics and provides an example of a scalable , low-cost environmental change that promotes healthy eating and decreases waste OBJECTIVE We sought to characterize student  receptivity to new menu offerings in the Los Angeles Unified School District by measuring the levels of fruit and vegetable waste after implementation of changes to the school lunch menu in fall 2011 . METHODS We measured waste at four r and omly selected middle schools in the school district , using two sources : a ) food prepared and left over after service ( production waste ) ; and b ) food that was selected but not eaten by students ( plate waste ) . RESULTS 10.2 % of fruit and 28.7 % of vegetable items prepared at the four schools were left over after service . Plate waste data , collected from 2228 students , suggest that many of them did not select fruit ( 31.5 % ) or vegetable ( 39.6 % ) items . Among students who did , many threw fruit and vegetable items away without eating a single bite . CONCLUSIONS Our findings suggest that fruit and vegetable waste was substantial and that additional work may be needed to increase student selection and consumption of fruit and vegetable offerings . Complementary interventions to increase the appeal of fruit and vegetable options may be needed to encourage student receptivity to these healthier items in the school meal program OBJECTIVE To assess whether a Smarter Lunchroom intervention based on behavioural economics and adapted for students with intellectual and developmental disabilities would increase the selection and consumption of fruits , vegetables and whole grains , and reduce the selection and consumption of refined grains . DESIGN The 3-month intervention took place at a residential school between March and June 2012 . The evaluation employed a quasi-experimental , pre-post design comparing five matched days of dietary data . Selection and plate waste of foods at lunch were assessed using digital photography . Consumption was estimated from plate waste . SETTING Massachusetts , USA . SUBJECTS Students ( n 43 ) aged 11 - 22 years with intellectual and developmental disabilities attending a residential school .  RESULTS Daily selection of whole grains increased by a mean of 0·44 servings ( baseline 1·62 servings , P = 0·005 ) and refined grains decreased by a mean of 0·33 servings ( baseline 0·82 servings , P = 0·005 ) . The daily consumption of fruits increased by a mean of 0·18 servings ( baseline 0·39 servings , P = 0·008 ) , whole grains increased by 0·38 servings ( baseline 1·44 servings , P = 0·008 ) and refined grains decreased by a mean of 0·31 servings ( baseline 0·68 servings , P = 0·004 ) . Total kilojoules and total gram weight of food selected and consumed were unchanged . Fruit ( P = 0·04 ) and vegetable ( P = 0·03 ) plate waste decreased . CONCLUSIONS A Smarter Lunchroom intervention significantly increased whole grain selection and consumption , reduced refined grain selection and consumption , increased fruit consumption , and reduced fruit and vegetable plate waste . Nudge approaches may be effective for improving the food selection and consumption habits of adolescents and young adults with intellectual and developmental disabilities IMPORTANCE Little is known about the long-term effect of a chef-enhanced menu on healthier food selection and consumption in school lunchrooms . In addition , it remains unclear if extended exposure to other strategies to promote healthier foods ( eg , choice architecture ) also improves food selection or consumption . OBJECTIVE To evaluate the short- and long-term effects of chef-enhanced meals and extended exposure to choice architecture on healthier school food selection and consumption . DESIGN , SETTING , AND PARTICIPANTS A school-based r and omized clinical trial was conducted during the 2011 - 2012 school year among 14 elementary and middle schools in 2 urban , low-income school districts ( intent-to-treat analysis ) . Included in the study were 2638 students in grade s 3 through 8 attending participating schools ( 38.4 % of eligible participants ) . INTERVENTIONS Schools were first r and omized to receive a professional chef to improve school meal palatability ( chef schools ) or to a delayed intervention ( control group ) . To assess the effect of choice architecture ( smart café ) , all schools after 3 months were then r and omized to the smart café intervention or to the control group . MAIN OUTCOMES AND MEASURES School food selection was recorded , and consumption was measured using plate waste methods . RESULTS After 3 months , vegetable selection increased in chef vs control schools ( odds ratio [ OR ] , 1.75 ; 95 % CI , 1.36 - 2.24 ) , but there was no effect on the selection of other components or on meal consumption . After long-term or extended exposure to the chef or smart café intervention , fruit selection increased in the chef ( OR , 3.08 ; 95 % CI , 2.23 - 4.25 ) , smart café ( OR , 1.45 ; 95 % CI , 1.13 - 1.87 ) , and chef plus smart café ( OR , 3.10 ; 95 % CI , 2.26 - 4.25 ) schools compared with the control schools , and consumption increased in the chef schools ( OR , 0.17 ; 95 % CI , 0.03 - 0.30 cups/d ) . Vegetable selection increased in the chef ( OR , 2.54 ; 95 % CI , 1.83 - 3.54 ) , smart café ( OR , 1.91 ; 95 % CI , 1.46 - 2.50 ) , and chef plus smart café schools ( OR , 7.38 , 95 % CI , 5.26 - 10.35 ) compared with the control schools , and consumption also increased in the chef ( OR , 0.16 ; 95 % CI , 0.09 - 0.22 cups/d ) and chef plus smart café ( OR , 0.13 ; 95 % CI , 0.05 - 0.19 cups/d ) schools ; however , the smart café intervention alone had no effect on consumption . CONCLUSIONS AND RELEVANCE Schools should consider both collaborating with chefs and using choice architecture to increase fruit and vegetable selection . Efforts to improve the taste of school foods through chef-enhanced meals should remain a priority because this was the only method that also increased consumption . This was observed only after students were repeatedly exposed to the new foods for 7 months . Therefore , schools should not ab and on healthier options if they are initially met with resistance . TRIAL REGISTRATION clinical trials.gov Identifier : NCT02309840 The object of this study was to determine whether students attending schools with self-service salad bars  consume a greater amount of  fruits and vegetables  compared with students using preportioned servings and to evaluate the relationship between number of items offered and fruit and vegetable consumption . Two hundred ninety-four students in first through fifth grade were r and omly selected from two schools with salad bars and two with preportioned servings .  Weights of fruit and vegetable items were measured pre- and postconsumption and interobserver agreement + /-1 g was > or = 95 % . Presence of a salad bar was not associated with greater fruit and vegetable consumption . Fruit and vegetable consumption was positively related to the number of fruit and vegetable items offered at salad bars ( P < .05 ) , adjusting for sex and grade . Fruit and vegetable variety was associated with elementary school-age children 's fruit and vegetable consumption when using salad bars OBJECTIVE To examine the effects of a multi-component , theory-based , 2.5-year intervention on children 's fruit and vegetable  consumption ,  preferences , knowledge and body mass index . METHODS Four inner city elementary schools in the Northeastern United States were r and omized to an intervention ( n=149 ) or control group ( n=148 ) in 2005 .  Fruit and vegetable  consumption during school lunch ( measured by plate waste ) , preferences , and knowledge , as well as body mass index , were assessed five times across 3.5 years ( pre 
    Output:
    
Fruits and vegetables were the most research ed dietary component on the lunch tray and yielded the greatest amount of waste across studies .