***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 ( FOP ) nutrition labelling has received growing attention from public health authorities , as a tool to promote healthier diets in the population . Recently , the French Health law introduced the principle of implementing a FOP nutrition labelling system . A scientific proposal has put forward the 5-Colour Nutrition Label ( 5-CNL ) , a five-category colour-coded summary system supported by research suggesting that it is well perceived and understood in the population . Our objective was to investigate the impact of the 5-CNL on the nutritional quality of purchases in experimental supermarkets . Methods Participants ( n = 901 ) were recruited using quota sampling between September and December 2015 and evenly distributed in three experimental conditions : 1 ) control situation ; 2 ) Application of the 5-CNL on all food products in three specific sections : breakfast cereals , sweet biscuits and appetizers ; 3 ) introduction of the 5-CNL accompanied by consumer information on use and underst and ing of the label . Main outcome was the nutritional quality of the shopping cart in the three sections combined , measured using the United Kingdom Food St and ards Agency nutrient profiling system ( FSA score ) . Results Significantly higher mean nutritional quality of the purchased items per section were observed for the sweet biscuits category in the intervention combining the label + communication ( overall FSA score 21.01 vs. 20.23 , P = 0.02 ) . No significant effects were observed for the general mean over the three sections combined or other food categories . The results observed on purchase may be related to the high level of recall , self-reported and objective underst and ing of the label that were observed in the intervention groups as they are pre-requisites for use of a label in purchasing situations . Conclusion These results suggest that the 5-CNL FOP nutrition label may have a limited impact on purchases , leading to healthier food choices in some food categories such as sweet biscuits . Trial registration The trial was registered on Clinical trials.gov under the number NCT02546505 OBJECTIVE We tested whether the presence of both  child-targeted and nutrition-focused ( i.e. parent-targeted ) marketing cues on food packaging was associated with the nutritional content of these products . DESIGN We conducted a quantitative content analysis of 403 food packages chosen r and omly from the supermarket 's online portal along with all products ( n 312 ) from the cereal aisle in a supermarket from the Southeastern USA . We examined main and interaction effects for cues on nutritional content ( e.g. energy density , sugar , sodium , fibre ) . SETTING A regional supermarket chain in the Southeastern USA . RESULTS Tests of main effects indicated that increased presence of nutritional cues was linked to more nutritious content ( e.g. less sugar , less saturated fat , more fibre ) while the increased presence of child-targeted cues was uniformly associated with less nutritious content ( e.g. more sugar , less protein , less fibre ) . Among the interaction effects , results revealed that products with increased nutrition-focused and child-targeted cues were likely to contain significantly more sugar and less protein than other products . CONCLUSIONS Products that seek to engage children with their packaging in the supermarket are significantly less nutritious than foods that do not , while product packages that suggest nutritional benefits have more nutritious content . More importantly , the study provides evidence that those products which try to engage both child and parent consumers are significantly less healthy in crucial ways ( e.g. more sugar , less fibre ) than products that do not This study aim ed to test whether counter-advertisements ( i.e. messages contesting industry marketing ) make pre-adolescent children less susceptible to the influence of food promotions . Since children have lower media literacy levels due to their immature cognitive abilities , specific research questions explored were : ( 1 ) whether the effectiveness of counter-ads is contingent on children having understood them ; and ( 2 ) whether counter-ads may be detrimental when they are misinterpreted . A between-subjects experimental design using a web-based methodology was employed . 1351 grade 5 - 6 students ( mean age 11 years ) from schools located in metropolitan Melbourne , Australia participated . Participants were r and omly shown an animated web banner advertisement ( counter-ad challenging front-of-package promotion or control ad ) and a pair of food packages from the same product category comprising an unhealthy product featuring a front-of-package promotion ( nutrient content cl aim or sports celebrity endorsement ) and a healthier control pack without a front-of-package promotion . Responses to the assigned advertisement , choice of product ( healthy versus unhealthy ) and ratings of the unhealthy product and front-of-package promotion on various nutritional and image-related attributes were recorded for each child . Sixty-six percent of children who viewed a counter-ad understood its main message . These children rated the front-of-package promotion as less believable and rated the unhealthy product bearing the front-of-package promotion as less healthy compared to the control group . However , children who misunderstood the counter-ad rated the unhealthy product bearing a front-of-package promotion as more healthy and rated the front-of-package promotion more favourably than those who correctly understood the counter-ad . Counter-advertising may have unintended consequences when misunderstood . If public health organizations or government pursue counter-advertising as a strategy to reduce the negative influence of unhealthy food marketing among children , caution is needed in design ing counter-ads to guard against possible contradictory effects 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 People typically eat more from large portions of food than from small portions . An explanation that has often been given for this so-called portion size effect is that the portion size acts as a social norm and as such communicates how much is appropriate to eat . In this paper , we tested this explanation by examining whether manipulating the relevance of the portion size as a social norm changes the portion size effect , as assessed by prospect i ve consumption decisions . We conducted one pilot experiment and one full experiment in which participants respectively indicated how much they would eat or serve themselves from a given amount of different foods . In the pilot ( N = 63 ) , we manipulated normative relevance by allegedly basing the portion size on the behavior of either students of the own university ( in-group ) or of another university ( out-group ) . In the main experiment ( N = 321 ) , we told participants that either a minority or majority of people similar to them approved of the portion size . Results show that in both experiments , participants expected to serve themselves and to eat more from larger than from smaller portions . As expected , however , the portion size effect was less pronounced when the reference portions were allegedly based on the behavior of an out-group ( pilot ) or approved only by a minority ( main experiment ) . These findings suggest that the portion size indeed provides normative information , because participants were less influenced by it if it communicated the behaviors or values of a less relevant social group . In addition , in the main experiment , the relation between portion size and the expected amount served was partially mediated by the amount that was considered appropriate , suggesting that concerns about eating an appropriate amount indeed play a role in the portion size effect . However , since the portion size effect was weakened but not eliminated by the normative relevance manipulations and since mediation was only partial , other mechanisms may also play a role In a cross-over study , participants ( n=59 ) were r and omly assigned to receive either 100 kcal packs or st and ard size packages of snacks for 1 week . After a minimum of a 1-week washout period , participants received the other form of the snack for 1 week . Snack consumption was recorded by participants in a diary . Participants consumed an average of 186.9 fewer grams of snacks per week when receiving 100 kcal snack packs compared to st and ard size packages of snacks . Post hoc comparisons revealed the effect of package size depended on both r and omization order and study week . Total grams of snacks consumed in week 1 differed significantly between the two r and omized groups . In week 2 , however , grams of snacks did not differ significantly between the two groups . This interaction was primarily due to a significantly lower consumption of snacks from st and ard size packages in the week following the portion-controlled packages . The results suggest that portion-controlled packaging reduce total intake from the provided snacks . Further , initial exposure to portion-controlled packages might have increased awareness of portion size such that less was consumed when larger packages were available Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies People consistently over-eat when served a large compared with a small ( appropriate ) portion of food . However , the mechanism underlying this so-called portion size effect is not well understood . We argue that the process of anchoring and adjustment naturally describes this effect , such that the size of a presented portion works as an anchor that strongly influences consumption . The classical anchoring and adjustment paradigm was applied to six hypothetical eating situations . Participants were asked to imagine being served either a small or a large portion of food ( i.e. , low and high anchor ) and to indicate whether they would consume more or less than this amount . Then , they indicated how much they would eat . These estimates were compared with a no-anchor condition where participants did not imagine a specific portion size but only indicated how much they would eat . In addition , half of participants in the anchoring conditions  received a discounting instruction stating that the portion size they had been asked to imagine was r and omly selected and thus not informative for their consumption estimate . As expected , participants who imagined to be served larger portions estimated to consume significantly more food than participants in the no-anchor condition , and participants who imagined to be served smaller portions estimated to consume significantly less food than participants in the no-anchor condition . The discounting manipulation did not reduce this effect of the anchors . We suggest that the process of anchoring and adjustment may provide a useful framework to underst and the portion size effect and we discuss implication s of this perspective Larger portion sizes increase energy intake , yet it is unclear whether single-serving packages can reduce intake . This study examined the effects of providing breakfast foods in single-serving packages and nonportioned packages on energy intake of these foods during an 8-week behavioral weight-loss program . In fall 2005 , 19 adults ( mean body mass index [ calculated as kg/m(2)]=31.8+/-4.0 ) were r and omized to conditions that provided foods in single-serving packages ( Single-Serving ) or in nonportioned packages ( St and ard ) . Overall amounts and types of foods provided were consistent across conditions : cereal and peaches ( weeks 1 , 3 , 5 , and 7 ) and applesauce and cheese ( weeks 2 , 4 , 6 , and 8) . Participants were instructed to eat one serving of each food for breakfast and not to consume the provided foods at other times . Mean daily energy intake of the provided foods was the primary dependent variable . The Single-Serving group ate less energy from the combined pairs of foods provided together as compared to St and ard ( cereal and peaches , 117.0+/-3.2 kcal/day vs 143.5+/-39.3 kcal/day ; P<0.05 and applesauce and cheese , 174.2+/-13.5 kcal/day vs 199.0+/-29.4 kcal/day ; P<0.05 ) . This effect was a result of less energy consumed from cereal and applesauce in Single-Serving compared to St and ard conditions ( cereal , 80.2+/-2.9 kcal/day vs 106.3+/-22.9 kcal/day ; P<0.01 and applesauce , 44.5+/-0.6 kcal/day vs 59.3+/-5.0 kcal/day ; P<0.01 ) , with no differences in energy consumption for pe 
    Output:
    
The results suggest that children and adults are susceptible to packaging cues , with most evidence supporting the impact of visual cues .
More specifically , children more often choose products with a licensed endorser and eat more from packages portraying the product with an exaggerated portion size .
Adults ’ eating behaviors are influenced by a range of other visual cues , mainly , package size and shape , and less so by informational cues such as labels