***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: Previous research has shown that restaurant menu design can influence food choices . However , it remains unknown whether such context ual effects on food selection are dependent on people 's past behavior . In the present study , we focused on vegetarian food choices , given their important implication s for the environment , and investigated whether the influence of different restaurant menus on the likelihood of selecting a vegetarian dish is moderated by the number of days on which people reported eating only vegetarian food during the previous week . In an online scenario , participants were r and omly assigned to four different restaurant menu conditions-control ( all dishes presented in the same manner ) , recommendation ( vegetarian dish presented as chef 's recommendation ) , descriptive ( more appealing description of vegetarian dish ) , and vegetarian ( vegetarian dishes placed in a separate section)- and ordered a dish for dinner . The results showed that the recommendation and descriptive menus increased the likelihood of vegetarian dish choices for infrequent eaters of vegetarian foods , whereas these effects tended to reverse for those who ate vegetarian meals more often . The vegetarian menu had no impact on the infrequent vegetarian eaters ' choice but backfired for the frequent vegetarian eaters and made them less likely to order a vegetarian dish . These findings indicate that people 's past behavior is an important determinant of the impact of nudging on food choices , and that achieving sustainable eating may require more personalized interventions Disease risk factors identified in epidemiological studies serve as important public health tools , helping clinicians identify individuals who may benefit from more aggressive screening or risk-modification procedures  , allowing policymakers to prioritize intervention programs , and encouraging at-risk individuals to modify behavior and improve their health . These factors have been based primarily on evidence from cross-sectional and prospect i ve studies , as most do not lend themselves to r and omized trials . While some risk factors are not modifiable , eating habits are subject to change through both individual action and broader policy initiatives . Meat consumption has been frequently investigated as a variable associated with diabetes risk , but it has not yet been described as a diabetes risk factor . In this article , we evaluate the evidence supporting the use of  meat consumption as a clinical ly useful risk factor for type 2 diabetes , based on studies evaluating the risks associated with  meat consumption  as a categorical dietary characteristic ( i.e. , meat consumption versus no meat consumption ) , as a scalar variable ( i.e. , gradations of meat consumption ) , or as part of a broader dietary pattern Background The aim of this research was to investigate whether increased portion sizes of vegetables and decreased portion sizes of meat on main dishes increased the amount of vegetables consumed in a real-life restaurant setting without affecting customer satisfaction . The participants were unaware of the experiment . Methods A cross-over design was used in which three restaurants were r and omly assigned to a sequence of an intervention and control condition . In the intervention period , the vegetable portion sizes on the plates of main dishes were doubled ( 150 g of vegetables instead of 75 g ) and the portion sizes of meat on the plates were reduced by an average of 12.5 % . In the control period , the portion sizes of the main dishes were maintained as usual . In total , 1006 observations and question naires were included . Results Vegetable consumption from plates was significantly higher during the intervention period ( M = 115.5 g ) than during the control period ( M = 61.7 g ) . Similarly , total vegetable consumption ( including side dishes ) was significantly higher during the intervention period ( M = 178.0 g ) than during the control period ( M = 137.0 g ) . Conversely , meat consumption was significantly lower during the intervention period ( M = 183.1 g ) than during the control period ( M = 211.1 g ) . Satisfaction with the restaurant visit did not differ between the intervention period ( M = 1.27 ) and control period ( M = 1.35 ) . Satisfaction with the main dish was significantly lower during the intervention period ( M = 1.25 ) than during the control period ( M = 1.38 ) , although in both cases , the scores indicated that participants remained ( very ) satisfied with their main dish . Conclusions This study showed that increasing vegetable portions in combination with decreasing meat portions ( unknowingly to the consumer ) increased the amount of vegetables consumed and decreased the amount of meat consumed . Furthermore , despite the changes in portion sizes , participants remained satisfied with their restaurant visit and main dish . The findings of this study suggest that modifying portion size in restaurants is an effective tool for stimulating vegetable consumption and consequently healthy and sustainable diets BACKGROUND Dietary recommendations emphasize increased consumption of fruit , vegetables , and whole grain cereals for prevention of chronic disease . OBJECTIVES This study assessed the effect of dietary advice and /or food provision on body weight and cardiovascular disease risk factors . METHODS Healthy overweight men ( n = 209 ) and women ( n = 710 ) , mean age 44.7 years , body mass index [ BMI ] 32.4 kg/m2 , were r and omized between November 2005 and August 2009 to receive Health Canada 's food guide ( control , n = 486 ) or 1 of 3 interventions : dietary advice consistent with both Dietary Approaches to Stop Hypertension ( DASH ) and dietary portfolio principles ( n = 145 ) ; weekly food provision reflecting this advice ( n = 148 ) ; or food delivery plus advice ( n = 140 ) . Interventions lasted 6 months with 12-month follow-up . Semiquantitative food frequency question naires and fasting blood , anthropometric and blood pressure measurements were obtained at baseline , 6 months , and 18 months . RESULTS Participant retention at 6 and 18 months was 91 % and 81 % , respectively , after food provision compared to 67 % and 57 % when no food was provided ( p < 0.0001 ) . Test and control treatments showed small reductions in body weight ( -0.8 to -1.2 kg ) , waist circumference ( -1.1 to -1.9 cm ) , and mean arterial pressure ( 0.0 to -1.1 mm Hg ) at 6 months and Framingham coronary heart disease risk score at 18 months ( -0.19 to -0.42 % ) , which were significant overall . Outcomes did not differ among test and control groups . CONCLUSIONS Provision of foods increased retention but only modestly increased intake of recommended foods . Current dietary recommendations showed small overall benefits in coronary heart disease risk factors . Additional dietary strategies to maximize these benefits are required . ( Fruits , Vegetables , and Whole Grains : A Community-based Intervention ; NCT00516620 ) OBJECTIVES We examined the efficacy of a cancer prevention intervention design ed to improve health behaviors among working-class , multiethnic population s employed in small manufacturing businesses . METHODS Worksites were r and omly assigned to an intervention or minimal-intervention control condition . The intervention targeted fruit and vegetable consumption , red meat consumption , multivitamin use , and physical activity . RESULTS Employees in the intervention group showed greater improvements for every outcome compared with employees in the control group . Differences in improvement were statistically significant for multivitamin use and physical activity . Intervention effects were larger among workers than among managers for fruit and vegetable consumption and for physical activity . CONCLUSIONS The social- context model holds promise for reducing disparities in health behaviors . Further research is needed to improve the effectiveness of the intervention Background Swaps are often used to encourage healthier food choices , but there is little evidence of their effectiveness . The current study assessed the impact of offering swaps on groceries purchased within a bespoke online supermarket ; specifically the objective was to measure the impact on energy density ( ED ) of food purchases following the offer of lower ED alternatives ( a ) at point of selection or at checkout , and ( b ) with or without explicit consent to receive swap prompts . Method Participants were asked to complete a 12-item shopping task within an online shopping platform , developed for study ing food purchasing . 1610 adults were r and omly assigned to a no swap control condition or to one of four interventions : consented swaps at selection ; consented swaps at checkout ; imposed swaps at selection ; or imposed swaps at checkout . Each swap presented two lower ED options from the same category as the participant ’s chosen food . Swap acceptance rate and purchased food ED were the primary outcomes . Results Of the mean 12.36 ( SD 1.26 ) foods purchased , intervention participants were offered a mean of 4.1 ( SD 1.68 ) swaps , with the potential to reduce the ED of purchased food ( effect ( 95 % CI ) : −83 kJ/100 g ( −110 – -56 ) , p = < 0.0001 ) . A median of one swap ( IQR 0 to 2 ) was accepted , not significantly reducing the purchased food ED ( effect ( 95 % CI ) : −24 kJ/100 g ( 4 – -52 ) , p = 0.094 ) . More swaps were accepted when offered at selection than at checkout ( OR ( 95 % CI ) = 1.224 ( 1.11 – 1.35 ) , p < 0.0001 ) , but no differences were seen with consent . Purchased food ED was unaffected by point of swap or consent , but reduced with number of swaps accepted ( effect per swap ( 95 % CI ) = −24 kJ/100 g ( −35 – -14 ) , p < 0.0001 ) . Conclusion Within category swaps did not reduce the ED of food purchases reflecting the observation that the use of swaps within an on-line shopping platform offered small potential gains in ED and a minority was accepted Abstract Background : Previous research from the fields of computer science and engineering highlight the importance of an iterative design process ( IDP ) to create more creative and effective solutions . Objective : This study describes IDP as a new method for developing health behavior interventions and evaluates the effectiveness of a dining hall – based intervention developed using IDP on college students ’ eating behavior and values . Participants : participants were 458 students ( 52.6 % female , age = 19.6 ± 1.5 years [ M ± SD ] ) . Methods : The intervention was developed via an IDP parallel process . A cluster-r and omized controlled study compared differences in eating behavior among students in 4 university dining halls ( 2 intervention , 2 control ) . Results : The final intervention was a multicomponent , point-of- selection marketing campaign . Students in the intervention dining halls consumed significantly less junk food and high-fat meat and increased their perceived importance of eating a healthful diet relative to the control group . Conclusion : IDP may be valuable for the development of behavior change interventions BACKGROUND The Cochrane Collaboration is strongly encouraging the use of a newly developed tool , the Cochrane Collaboration Risk of Bias Tool ( CCRBT ) , for all review groups . However , the psychometric properties of this tool to date have yet to be described . Thus , the objective of this study was to add information about psychometric properties of the CCRBT including inter-rater reliability and concurrent validity , in comparison with the Effective Public Health Practice Project Quality Assessment Tool ( EPHPP ) . METHODS Both tools were used to assess the method ological quality of 20 r and omized controlled trials included in our systematic review of the effectiveness of knowledge translation interventions  to improve the management of cancer pain . Each study assessment was completed independently by two review ers using each tool . We analysed the inter-rater reliability of each tool 's individual domains , as well as final grade assigned to each study . RESULTS The EPHPP had fair inter-rater agreement for individual domains and excellent agreement for the final grade . In contrast , the CCRBT had slight inter-rater agreement for individual domains and fair inter-rater agreement for final grade . Of interest , no agreement between the two tools was evident in their final grade assigned to each study . Although both tools were developed to assess ' quality of the evidence ' , they appear to measure different constructs . CONCLUSIONS Both tools performed quite differently when evaluating the risk of bias or method ological quality of studies in knowledge translation interventions for cancer pain . The newly introduced CCRBT assigned these studies a higher risk of bias . Its psychometric properties need to be more thoroughly vali date d , in a range of research fields , to underst and fully how to interpret results from its application ABSTRACT Background Diet is an important determinant of health , and food purchasing is a key antecedent to consumption . Objective We set out to evaluate the effectiveness of grocery store interventions to change food purchasing , and to examine whether effectiveness varied based on intervention components , setting , or socioeconomic status . Design We conducted a systematic review of r and omized controlled trials ( search performed June 2017 ) . Studies must have : aim ed to change food purchasing ; been implemented in grocery stores ( real or simulated ) ; reported purchasing ; and had a minimal control or compared interventions fulfilling our criteria . Search ing , screening , bias assessment , and data extraction followed Cochrane methods . We grouped studies by intervention type ( economic , environmental , swaps , and /or education ) , synthesized results narratively , and conducted an exploratory qualitative comparative analysis . Results We included 35 studies representing 89 interventions , > 20,000 participants , and > 800 stores . Risk of bias was mixed . Economic interventions showed the most promise , with 8 of the 9 studies in real stores and all 6 in simulated environments detecting an effect on purchasing . Swap interventions appeared promising in the 2 studies based in real stores . Store environment interventions showed mixed effects . Education-only interventions appeared effective in simulated environments but not in real stores . Available data suggested that effects of economic interventions did not differ by socioeconomic status , whereas for other interventions impact was variable . In our qualitative comparative analysis , economic interventions ( regardless of setting ) and environmental and swap interventions in real stores were associated with statistically significant changes in purchasing in the desired direction for ≥1 of the foods targeted by the intervention , whereas education-only interventions in real stores were not . Conclusions Findings suggest that inter 
    Output:
    
INTERPRETATION Some interventions restructuring physical micro-environments could help to promote lower dem and for meat .
Interventions reducing portion sizes of meat servings , providing meat alternatives , or changing the sensory properties of meat and meat alternatives at point of purchase offered the most promise in the context of experimental studies .