***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: OBJECTIVE To evaluate an intervention to improve food label knowledge and skills in diabetes management among older adults with diabetes mellitus . DESIGN A r and omized pretest-posttest control group design was used . SUBJECTS/ SETTING Participants ( 48 experimental , 50 control ) were aged 65 years and older with type 2 diabetes for 1 year or longer ; 93 participants ( 95 % ) completed the study , conducted in an outpatient setting . INTERVENTION The intervention included 10 weekly group sessions led by a dietitian . Information processing , learning theory , and Social Cognitive Theory principles were used in program development and evaluation . MAIN OUTCOME MEASURES Participants ' knowledge , outcome expectations ( expected results of behavior ) , self-efficacy , and decision-making skills were assessed . Instrument validity and reliability were established before program evaluation . STATISTICAL ANALYSES PERFORMED Factor analysis identified underlying factor structures . Analysis of covariance with pretest score as covariate was used to compare groups at posttest . Paired t tests compared results within groups . RESULTS Two factors were identified for outcome expectations ( positive and negative ) and for self-efficacy ( promoters of and barriers to diabetes management ) . The experimental group had greater improvement in total knowledge scores ( mean + /- st and ard error of the mean : 7.8+/-0.7 ) than the control group ( 0.2+/-0.7 ) ( P < .0001 ) , positive outcome expectations ( 0.59+/-0.15 vs 0.06+/-0.15 , P = .01 ) , promoters of diabetes management ( 0.83+/-0.12 vs -0.09+/-0.18 , P < or = .001 ) and decision-making skills ( 5.1+/-0.5 vs 0.3+/-0.5 , P < .0001 ) and greater reduction in barriers to diabetes management ( 1.1+/-0.16 vs 0.34+/-0.16 , P < .01 ) . No significant difference in negative outcome expectations occurred between groups at posttest . APPLICATIONS/ CONCLUSIONS Older adults with diabetes can benefit from nutrition education design ed to improve knowledge and skills necessary for diabetes management Background The deterioration of the health status of the Romanian population during the economic transition from a central ly planned to a free market economy has been linked to lifestyles factors ( e.g. diet ) regarded as a main determinants of the disparity in life expectancy between Eastern and Western Europe . Reforms in the health care system in this transition economy aim to focus on preventive action . The purpose of this study was to identify the factors that impact on the individual decision to engage in  Dietary Health Preventive Behaviour  ( DHPB ) and investigate their influence in the context of an adapted health cognition model . Methods A population -based study recruited 485 adult respondents using r and om route sampling and face-to-face administered question naires .  Results and discussion Respondents ' health motivation , beliefs that diet can prevent disease , knowledge about nutrition , level of education attainment and age have a positive influence on DHPB . Perceived barriers to healthy eating have a negative impact on alcohol moderation . The information acquisition behaviour ( frequency of reading food labels ) is negatively predicted by age and positively predicted by health motivation , education , self-reported knowledge about nutrition and household financial status . A significant segment of respondents believe they are not susceptible to the elicited diseases . Health promotion strategies should aim to change the judgments of health risk . Conclusion The adaptation of the Health Belief Model and the Theory of Health Preventive Behaviour represents a valid framework of predicting DHPB . The negative sign of perceived threat of disease on DHPB may suggest that , under an income constraint , consumers tend to trade off long-term health benefits for short-term benefits . This caution s against the use of negative messages in public health campaigns . Raising the awareness of diet-disease relationships , knowledge about nutrition ( particularly sources and risks associated with dietary fat and cholesterol ) may induce people to adopt preventive dietary habits 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 This study investigated whether the energy density of foods affected energy intake when subjects were informed about the energy density of their meals . Forty normal-weight women ate breakfast , lunch , and dinner in the laboratory on three separate days . The entrée at each meal was varied in energy density to be either 1.25 , 1.50 , or 1.75 kcal/g ( 5.23 , 6.28 , or 7.32 kJ/g ) , but was held similar in macronutrient composition and palatability . On each day , the entrées at all three meals had the same energy density . All entrées were consumed ad libitum . Subjects were assigned to one of two groups . Subjects in the information group received a nutrition label with each meal , which showed the energy density of the entrée . Subjects in the no-information group did not receive any nutrition information . The results revealed that subjects in both groups had the same pattern of food intake across the three levels of energy density . Energy density significantly affected energy intake ; subjects in both groups combined consumed 22 % less energy in the condition of low energy density than in the condition of high energy density ( p < 0.0001 ) . These findings show that energy density can have a significant influence on energy intake , even when individuals are informed about the energy density of their meals OBJECTIVE The purpose of this study was to measure the reported use of nutrition information on food labels by a population of university students and to determine if label users differed from non-users in terms of gender and specific beliefs related to label information and diet-disease relationships , specifically fat and heart disease and fibre and cancer . DESIGN A single-stage cluster sampling technique was used . Data was obtained using a self-administered , vali date d question naire . SETTING The present investigation took place at the University of Saskatchewan , Canada in the autumn of 1997 . SUBJECTS : A total of 553 students in r and omly selected classes in the College of Arts and Science took part in the survey ( 92 % response rate ) . The sample consisted of roughly equal numbers of males and females , most between the ages of 18 and 24 . RESULTS There were approximately equal numbers of label users and non-users among males , while label users outnumbered non-users by almost four to one among females . The importance of nutrition information on food labels was the only belief that differed significantly between label users and non-users for both sexes . For females , no other beliefs distinguished label users from non-users . However , for males , significant differences were found between label users and non-users on the beliefs that nutrition information is truthful and that a relationship between fibre and cancer exists . CONCLUSIONS Females appear to use food labels more often than do males . The only consistently observed difference between label users and non-users ( male and female ) was that users believed in the importance of nutrition information on food labels while non-users did not This study investigated whether energy from fat , nutrition information , and /or repeated consumption of a palatable snack food affects the development of sensory-specific satiety ( SSS ) .  Participants ( 51 males and 44 females ) ate an afternoon snack of potato chips in a laboratory for two 10-day ( Monday-Friday ) sessions in a repeated measures , cross-over design . In one 10-day session , participants were given regular , full-fat potato chips ( 22.2 kJ/g ; 150 kcal/oz ) and , in the other , they were given potato chips made with olestra ( 11.8 kJ/g ; 80 kcal/oz ) , a non-absorbable fat replacer . Information about the fat and energy content of the chips was provided to half the participants , while the other half was not informed . In both sessions , participants were instructed to consume the potato chips ad libitum . Initial ratings of sensory properties of the two types of chips did not differ significantly . In SSS tests , participants rated sensory properties of the chips and four test foods ( turkey , strawberry yogurt , cookie , and carrot ) on days 1 , 5 , and 10 of the 10-day sessions . Following consumption , ratings of pleasantness of taste and texture and prospect i ve consumption of both types of chips declined compared to the test foods . Further analyses showed that the development of SSS was not affected by the fat and energy content of the chips , the provision of nutrition information , or repeated consumption OBJECTIVE To identify sociodemographic variables and beliefs about the causes of obesity associated with reported use of Nutrition Facts panel ( NFP ) information . DESIGN / SETTING Nationally representative , cross-sectional survey of 1139 adults . Data collection employed a single-stage , equal-probability sampling design with r and om-digit dialing across 50 states and the District of Columbia . Analysis sample consisted of 390 adults living with one or more children who reported making food purchasing decisions . MAIN OUTCOME MEASURE Respondents provided self-reported information on their use of  NFP information when making food purchasing decisions for their household . ANALYSIS Chi-square and analysis of variance ( ANOVA ) tests compared the analysis sample to the broader population . Logistic regression analyses identified the sociodemographic and beliefs about obesity variables related to NFP use . RESULTS Fifty-three percent of the sample reported using  NFP  information on a consistent basis . Females , those with more education , and those currently married were more likely to use NFP labels . The importance of knowledge in order to maintain healthy body weight was the only belief variable associated with use of NFP information . IMPLICATION S FOR RESEARCH AND PRACTICE Nutrition educators interested in changing dietary behaviors should begin by identifying levels of nutritional literacy and beliefs about the importance of nutrition to motivate use of NFP labels OBJECTIVES This study compared use of food labels before and after implementation of new Food and Drug Administration regulations in 1994 . METHODS Data were obtained by r and  om-digit-dial surveys of Washington State residents in 1993 ( n = 1001 ) and 1996 ( n = 1450 ) . RESULTS After implementation of the new regulations , usual label use increased significantly , by 8.5 percentage points in women and 11.3 percentage points in men . More respondents looked for information on fat content and fewer failed to use labels because they " take too much time " or " are too hard to underst and . CONCLUSIONS Use of food labels  and satisfaction with their content have increased , but 70 % of adults still want labels to be easier to underst and To determine knowledge , attitudes , behaviors , and self-reported cholesterol measurement in a low-income , urban patient population , we conducted an interview survey of users and potential users of primary care services in a public health care system for low-income Harris County , Texas , residents . The response rate was 93 % , with a final sample of 547 r and omly selected subjects 18 years of age and older , who were Hispanic ( 54 % ) , black ( 28 % ) , non-Hispanic white ( 14 % ) , and Asian , Native American , or other ( 4 % ) . Results indicated that 76 % had heard of serum or blood cholesterol , and 30 % reported past cholesterol measurement . Knowledge that dietary saturated fat can raise blood cholesterol ranged from 11 % in Hispanic men to 51 % in non-Hispanic white men and women . A lower percentage of Hispanics correctly answered all knowledge questions , and Hispanics reported higher-fat food choices than blacks and non-Hispanic whites . More than 90 % of the respondents expressed interest in more information on diet , 60 % reported that they read nutrition labels , and 15 % said they have been trying to reduce blood cholesterol levels . A lower percentage of Hispanics reported previous cholesterol measurement than blacks or non-Hispanic whites , a difference that persisted after adjusting for multiple factors associated with cholesterol measurement . Older age ( older than 50 ) and more physician visits in the past year also were associated with past cholesterol measurement . Comparisons with national surveys show that 
    Output:
    
RESULTS Nutrition labels on pre-packaged foods are among the most prominent sources of nutrition information .
Nutrition labels are perceived as a highly credible source of information and many consumers use nutrition labels to guide their selection of food products .
Evidence also shows a consistent link between the use of nutrition labels and healthier diets .
However , the use of labels varies considerably across subgroups , with lower use among children , adolescents and older adults who are obese .
Nutrition labels on pre-packaged foods are a cost-effective population -level intervention with unparalleled reach .