human
***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 Owing to modern lifestyles , individuals are dependent on out-of-home eating . The catering sector can have a pivotal role in influencing our food choices . The objective of the present study was to examine the impact of a structured catering initiative on food choices in a public sector workplace setting . DESIGN A cross-sectional comparison study in two hospitals , one of which had implemented a catering initiative design ed to provide nutritious food while reducing sugar , fat and salt intakes . SETTING Two public sector hospitals in Cork , Irel and . SUBJECTS A total of 100 r and om participants aged 18 - 64 years ( fifty intervention , fifty non-intervention ) who consumed at least one main meal in the hospital staff canteen daily .  Each respondent was asked to complete one anonymous 24 h dietary recall and question naire . Food and nutrient analysis was conducted using WISP ( Weighed Intake Software Program ) . RESULTS Reported mean intakes of total sugars ( P < 0·001 ) , total fat ( P < 0·000 ) , saturated fat ( P < 0·000 ) and salt ( P < 0·046 ) were significantly lower in the intervention hospital when adjusted for age and gender . In the intervention hospital , 72 % of respondents , compared with 42 % in the non-intervention hospital , complied with the recommended under-3 daily servings of food high in fat and sugar ( P < 0·005 ) . In the intervention hospital , 43 % of respondents exceeded the recommended salt intake of 4 - 6 g/d , compared with 57 % in the non-intervention hospital . CONCLUSIONS Structured catering initiatives in the workplace are a potentially important option in the promotion of healthy food choices . Targeted public health programmes and health policy changes are needed to motivate caterers in the public sector and other industries to develop interventions that promote a healthy diet OBJECTIVE To evaluate the effectiveness of a worksite health promotion program on improving cardiovascular disease risk factors . METHODS In St Louis , Missouri from 2005 to 2006 , 151 employees ( 134 F , 17 M , 81 % overweight/obese ) participated in a cohort-r and omized trial comparing assessment s + intervention ( worksite A ) with assessment s only ( worksite B ) for 1 year . All participants received personal health reports containing their assessment results . The intervention was design ed to promote physical activity and favorable dietary patterns using pedometers , healthy snack cart , WeightWatchers(R ) meetings , group exercise classes , seminars , team competitions , and participation rewards . Outcomes included BMI , body composition , blood pressure , fitness , lipids , and Framingham 10-year coronary heart disease risk . RESULTS 123 participants , aged 45+/-9 yr , with BMI 32.9+/-8.8 kg/m(2 ) completed 1 year . Improvements ( P < or = 0.05 ) were observed at both worksites for fitness , blood pressure , and total- , HDL- , and LDL-cholesterol . Additional improvements occurred at worksite A in BMI , fat mass , Framingham risk score , and prevalence of the metabolic syndrome ; only the changes in BMI and fat mass were different between worksites . CONCLUSION A multi-faceted worksite intervention promoted favorable changes in cardiovascular disease risk factors , but many of the improvements were achieved with worksite health assessment s and personalized health reports in the absence of an intervention This study investigated the effectiveness of labeling foods with the Choices nutrition logo on influencing cafeteria menu selection and the behavioral determinants of menu choices in work site cafeterias in the Netherl and s. A cluster r and omized controlled trial was conducted .  Intervention cafeterias ( n=13 ) , where the Choices logo was used to promote healthier eating for a 3-week period , were compared with control cafeterias ( n=12 ) , which offered the same menu without the logo .  Sales data were collected daily for 9 weeks , from March to May 2009 . In addition , employees from one intervention and one control company completed an online question naire at baseline and after the intervention ( n=368 ) in which the behavioral determinants of food choice ( ie , attitude , self-efficacy , and intention ) and logo use were measured . Generalized estimating equation analyses , χ² tests , t tests and linear regression analyses were performed . No nutritionally meaningful intervention effects were found in the sales of s and wiches , soups , snacks , fruit , and salads . Also , no significant differences in behavioral determinants were found . " Intention to eat healthier " and " paying attention to product information " were positively associated with self-reported consumption of foods with the Choices logo at lunch . The intervention did not have a significant effect on employees ' lunchtime food choices . Labeling healthy choices might be useful for health-conscious employees in the volitional phase of behavior change . Further research should focus on the possible health benefits of menu reformulation in the catering sector Purpose . To report findings from Treatwell 5-a-Day process tracking . Design . Worksites were r and omly assigned to a minimal intervention control , worksite-only condition , or worksite-plus-family condition . Setting . Twenty-two small community health centers in Massachusetts . Subjects . Employees of the community health centers . Intervention . Both intervention conditions included the formation of employee advisory boards ; activities such as nutrition discussion s and taste tests targeting individual behavior change ; and point-of-purchase labeling as an environmental strategy . Worksite-plus-family sites incorporated activities such as family contests , campaigns , and picnics . Measures . Documentation of the number and type of activities for extent of implementation ; number of participants in activities for reach ; program awareness and participation from the follow-up employee survey ( n = 1306 , representing 76 % [ range , 56%–100 % ] of the sample ) ; change in fruit and vegetable consumption from a comparison between the follow-up and baseline surveys ( n = 1359 , representing 87 % [ range , 75%–100 % ] of the sample ) . Results . A higher number of activities per employee was significantly correlated with greater program awareness ( . 68 ; p = . 006 ) and greater change in fruit and vegetable consumption ( .55 ; p = .04 ) . Greater participation in activities was significantly correlated with greater awareness ( .67 ; p = .007 ) , higher participation ( .61 ; p = .02 ) , and increase in fruit and vegetable consumption . ( .55 ; p = .04 ) . Conclusions . These results provide quantitative indicators of a dose-response relationship between the number of intervention activities per employee and higher percentage of employee participation and observed increases in fruit and vegetable consumption Background : Environmental interventions directed at portion size might help consumers to reduce their food intake . Objective : To assess whether offering a smaller hot meal , in addition to the existing size , stimulates people to replace their large meal with a smaller meal . Design : Longitudinal r and omized controlled trial assessing the impact of introducing small portion sizes and pricing strategies on consumer choices . Setting / participants : In all , 25 worksite cafeterias and a panel consisting of 308 consumers ( mean age=39.18 years , 50 % women).Intervention : A small portion size of hot meals was offered in addition to the existing size . The meals were either proportionally priced ( that is , the price per gram was comparable regardless of the size ) or value size pricing was employed . Main outcome measures : Daily sales of small and the total number of meals , consumers ’ self-reported compensation behavior and frequency of purchasing small meals . Results : The ratio of small meals sales in relation to large meals sales was 10.2 % . No effect of proportional pricing was found B=−0.11 ( 0.33 ) , P=0.74 , confidence interval ( CI ) : −0.76 to 0.54 ) . The consumer data indicated that 19.5 % of the participants who had selected a small meal often-to-always purchased more products than usual in the worksite cafeteria . Small meal purchases were negatively related to being male ( B=−0.85 ( 0.20 ) , P=0.00 , CI : −1.24 to −0.46 , n=178 ) . Conclusion : When offering a small meal in addition to the existing size , a percentage of consumers that is considered reasonable were inclined to replace the large meal with the small meal . Proportional prices did not have an additional effect . The possible occurrence of compensation behavior is an issue that merits further attention The National Cancer Institute 's ' 5-a-Day for Better Health Campaign is examining the efficacy of interventions in increasing the consumption of fruits and vegetables to five or more servings a day . This paper presents the study design , intervention and baseline survey results of the Treatwell 5-a-Day project , a r and omized , controlled worksite-based intervention study . Twenty-two community health centers were r and omly assigned to either a Minimal Intervention , Worksite Intervention or Worksite Plus Family Intervention . The Worksite Intervention included participation of employee advisory boards , programs aim ed at individual behavior change and programs aim ed at changes in the worksite environment . The Worksite Plus Family Intervention incorporated family-focused interventions into the worksite program , including a learn-at-home program , family newsletter , family festival and material s mailings . A self-administered survey was conducted prior to r and omization ( mean response rate : 87 % , n = 1359 ) . Twenty-three percent reported consuming five or more servings of fruits and vegetables a day . Consumption of fruits and vegetables was directly associated with level of household support for healthy eating . The Treatwell 5-a-Day intervention model has the potential to enhance existing worksite-based intervention through incorporation of its family focus , especially given the association of household support with individual eating habits The objective of this study was to evaluate an intervention that combined mindful eating and online pre-ordering to promote healthier lunch purchases at work . The study took place at an urban hospital with 26 employees who were overweight or obese . The design included a contemporaneous comparison with delayed-treatment control and a three-phase prospect i ve study . A minimum 4-week baseline period preceded a 4-week full-intervention , in which participants received mindful eating training , pre-ordered their lunches , and received price discounts toward lunch purchases . In a 4-week reduced intervention phase , participants pre-ordered lunches without price discounts . Participant lunch purchases were tracked electronically at the point of purchase . The primary outcome measures were the amounts of kilocalories and fat grams in purchased lunches . In contemporaneous comparisons , the treatment group purchased lunches with an average of 144.6 fewer kilocalories ( p = 0.01 ) and 8.9 fewer grams of fat ( p = 0.005 ) compared to controls . In multivariable longitudinal analyses , participants decreased the average number of calories in their meals by 114.6 kcal per lunch and the average grams of fat by 5.4 per lunch during the partial-intervention compared to the baseline ( p < 0.001 ) . At the end of the study , a moderate increase was observed in participants ' overall mindful eating behaviors as compared to the beginning of the study ( p < 0.001 ) . The majority of participants ( 92 % ) said they would use the pre-ordering system if offered in the future . Combined mindful eating training and online pre-ordering appears a feasible and useful worksite intervention to improve food choices by employees BACKGROUND 5 a Day for Better Health is a simple message encouraging people to eat more fruits and vegetables . The Seattle 5 a Day worksite investigators design ed and evaluated an intervention , organized on stages of behavioral change , to increase worksitewide fruit and vegetable consumption . METHODS We recruited 28 worksites with cafeterias and r and omized 14 to intervention and 14 to control . The intervention addressed both changes in the work environment and individual level behavior change . In each worksite , an employee advisory board , with study interventionist assistance , implemented the program . By surveying cross-sectional sample s of 125 employees per worksite , we compared worksite mean fruit and vegetable consumption at 2-year follow-up with that at baseline .  Unobtrusive site-level indicators including plate observation and cafeteria checklist  were also used . RESULTS The difference at 2 years was 0.5 for the intervention worksites and 0.2 for the control worksites , with an intervention effect of 0.3 daily serving ( P < 0.05 ) . Other measures of fruit and vegetable consumption , including unobtrusive indicators , supported the effectiveness of the intervention . CONCLUSIONS This simple 5 a Day intervention is feasible and acceptable for use in worksites with cafeterias . There was a significant differential increase in fruit and vegetable consumption in the intervention worksites . This kind of worksite intervention can achieve important health benefits on a population basis , because of its potential to reach large numbers of people BACKGROUND Preventing obesity requires maintenance of healthy eating behaviors over time . Food labels and strategies that increase visibility and convenience of healthy foods ( choice architecture ) promote healthier choices , but long-term effectiveness is unknown . PURPOSE Assess effectiveness of traffic-light labeling and choice architecture cafeteria intervention over 24 months . DESIGN Longitudinal pre-post cohort follow-up study between December 2009 and February 2012 . Data were analyzed in 2012 . SETTING / PARTICIPANTS Large hospital cafeteria with a mean of 6511 transactions daily . Cafeteria sales were analyzed for ( 1 ) all cafeteria customers and ( 2 ) a longitudinal cohort of 2285 hospital employees who used the cafeteria regularly . INTERVENTION After a 3-month baseline period , cafeteria items were labeled green ( healthy ) ; yellow ( less healthy ) ; or red ( unhealth 
    Output:
    
agent
***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 Owing to modern lifestyles , individuals are dependent on out-of-home eating . The catering sector can have a pivotal role in influencing our food choices . The objective of the present study was to examine the impact of a structured catering initiative on food choices in a public sector workplace setting . DESIGN A cross-sectional comparison study in two hospitals , one of which had implemented a catering initiative design ed to provide nutritious food while reducing sugar , fat and salt intakes . SETTING Two public sector hospitals in Cork , Irel and . SUBJECTS A total of 100 r and om participants aged 18 - 64 years ( fifty intervention , fifty non-intervention ) who consumed at least one main meal in the hospital staff canteen daily .  Each respondent was asked to complete one anonymous 24 h dietary recall and question naire . Food and nutrient analysis was conducted using WISP ( Weighed Intake Software Program ) . RESULTS Reported mean intakes of total sugars ( P < 0·001 ) , total fat ( P < 0·000 ) , saturated fat ( P < 0·000 ) and salt ( P < 0·046 ) were significantly lower in the intervention hospital when adjusted for age and gender . In the intervention hospital , 72 % of respondents , compared with 42 % in the non-intervention hospital , complied with the recommended under-3 daily servings of food high in fat and sugar ( P < 0·005 ) . In the intervention hospital , 43 % of respondents exceeded the recommended salt intake of 4 - 6 g/d , compared with 57 % in the non-intervention hospital . CONCLUSIONS Structured catering initiatives in the workplace are a potentially important option in the promotion of healthy food choices . Targeted public health programmes and health policy changes are needed to motivate caterers in the public sector and other industries to develop interventions that promote a healthy diet OBJECTIVE To evaluate the effectiveness of a worksite health promotion program on improving cardiovascular disease risk factors . METHODS In St Louis , Missouri from 2005 to 2006 , 151 employees ( 134 F , 17 M , 81 % overweight/obese ) participated in a cohort-r and omized trial comparing assessment s + intervention ( worksite A ) with assessment s only ( worksite B ) for 1 year . All participants received personal health reports containing their assessment results . The intervention was design ed to promote physical activity and favorable dietary patterns using pedometers , healthy snack cart , WeightWatchers(R ) meetings , group exercise classes , seminars , team competitions , and participation rewards . Outcomes included BMI , body composition , blood pressure , fitness , lipids , and Framingham 10-year coronary heart disease risk . RESULTS 123 participants , aged 45+/-9 yr , with BMI 32.9+/-8.8 kg/m(2 ) completed 1 year . Improvements ( P < or = 0.05 ) were observed at both worksites for fitness , blood pressure , and total- , HDL- , and LDL-cholesterol . Additional improvements occurred at worksite A in BMI , fat mass , Framingham risk score , and prevalence of the metabolic syndrome ; only the changes in BMI and fat mass were different between worksites . CONCLUSION A multi-faceted worksite intervention promoted favorable changes in cardiovascular disease risk factors , but many of the improvements were achieved with worksite health assessment s and personalized health reports in the absence of an intervention This study investigated the effectiveness of labeling foods with the Choices nutrition logo on influencing cafeteria menu selection and the behavioral determinants of menu choices in work site cafeterias in the Netherl and s. A cluster r and omized controlled trial was conducted .  Intervention cafeterias ( n=13 ) , where the Choices logo was used to promote healthier eating for a 3-week period , were compared with control cafeterias ( n=12 ) , which offered the same menu without the logo .  Sales data were collected daily for 9 weeks , from March to May 2009 . In addition , employees from one intervention and one control company completed an online question naire at baseline and after the intervention ( n=368 ) in which the behavioral determinants of food choice ( ie , attitude , self-efficacy , and intention ) and logo use were measured . Generalized estimating equation analyses , χ² tests , t tests and linear regression analyses were performed . No nutritionally meaningful intervention effects were found in the sales of s and wiches , soups , snacks , fruit , and salads . Also , no significant differences in behavioral determinants were found . " Intention to eat healthier " and " paying attention to product information " were positively associated with self-reported consumption of foods with the Choices logo at lunch . The intervention did not have a significant effect on employees ' lunchtime food choices . Labeling healthy choices might be useful for health-conscious employees in the volitional phase of behavior change . Further research should focus on the possible health benefits of menu reformulation in the catering sector Purpose . To report findings from Treatwell 5-a-Day process tracking . Design . Worksites were r and omly assigned to a minimal intervention control , worksite-only condition , or worksite-plus-family condition . Setting . Twenty-two small community health centers in Massachusetts . Subjects . Employees of the community health centers . Intervention . Both intervention conditions included the formation of employee advisory boards ; activities such as nutrition discussion s and taste tests targeting individual behavior change ; and point-of-purchase labeling as an environmental strategy . Worksite-plus-family sites incorporated activities such as family contests , campaigns , and picnics . Measures . Documentation of the number and type of activities for extent of implementation ; number of participants in activities for reach ; program awareness and participation from the follow-up employee survey ( n = 1306 , representing 76 % [ range , 56%–100 % ] of the sample ) ; change in fruit and vegetable consumption from a comparison between the follow-up and baseline surveys ( n = 1359 , representing 87 % [ range , 75%–100 % ] of the sample ) . Results . A higher number of activities per employee was significantly correlated with greater program awareness ( . 68 ; p = . 006 ) and greater change in fruit and vegetable consumption ( .55 ; p = .04 ) . Greater participation in activities was significantly correlated with greater awareness ( .67 ; p = .007 ) , higher participation ( .61 ; p = .02 ) , and increase in fruit and vegetable consumption . ( .55 ; p = .04 ) . Conclusions . These results provide quantitative indicators of a dose-response relationship between the number of intervention activities per employee and higher percentage of employee participation and observed increases in fruit and vegetable consumption Background : Environmental interventions directed at portion size might help consumers to reduce their food intake . Objective : To assess whether offering a smaller hot meal , in addition to the existing size , stimulates people to replace their large meal with a smaller meal . Design : Longitudinal r and omized controlled trial assessing the impact of introducing small portion sizes and pricing strategies on consumer choices . Setting / participants : In all , 25 worksite cafeterias and a panel consisting of 308 consumers ( mean age=39.18 years , 50 % women).Intervention : A small portion size of hot meals was offered in addition to the existing size . The meals were either proportionally priced ( that is , the price per gram was comparable regardless of the size ) or value size pricing was employed . Main outcome measures : Daily sales of small and the total number of meals , consumers ’ self-reported compensation behavior and frequency of purchasing small meals . Results : The ratio of small meals sales in relation to large meals sales was 10.2 % . No effect of proportional pricing was found B=−0.11 ( 0.33 ) , P=0.74 , confidence interval ( CI ) : −0.76 to 0.54 ) . The consumer data indicated that 19.5 % of the participants who had selected a small meal often-to-always purchased more products than usual in the worksite cafeteria . Small meal purchases were negatively related to being male ( B=−0.85 ( 0.20 ) , P=0.00 , CI : −1.24 to −0.46 , n=178 ) . Conclusion : When offering a small meal in addition to the existing size , a percentage of consumers that is considered reasonable were inclined to replace the large meal with the small meal . Proportional prices did not have an additional effect . The possible occurrence of compensation behavior is an issue that merits further attention The National Cancer Institute 's ' 5-a-Day for Better Health Campaign is examining the efficacy of interventions in increasing the consumption of fruits and vegetables to five or more servings a day . This paper presents the study design , intervention and baseline survey results of the Treatwell 5-a-Day project , a r and omized , controlled worksite-based intervention study . Twenty-two community health centers were r and omly assigned to either a Minimal Intervention , Worksite Intervention or Worksite Plus Family Intervention . The Worksite Intervention included participation of employee advisory boards , programs aim ed at individual behavior change and programs aim ed at changes in the worksite environment . The Worksite Plus Family Intervention incorporated family-focused interventions into the worksite program , including a learn-at-home program , family newsletter , family festival and material s mailings . A self-administered survey was conducted prior to r and omization ( mean response rate : 87 % , n = 1359 ) . Twenty-three percent reported consuming five or more servings of fruits and vegetables a day . Consumption of fruits and vegetables was directly associated with level of household support for healthy eating . The Treatwell 5-a-Day intervention model has the potential to enhance existing worksite-based intervention through incorporation of its family focus , especially given the association of household support with individual eating habits The objective of this study was to evaluate an intervention that combined mindful eating and online pre-ordering to promote healthier lunch purchases at work . The study took place at an urban hospital with 26 employees who were overweight or obese . The design included a contemporaneous comparison with delayed-treatment control and a three-phase prospect i ve study . A minimum 4-week baseline period preceded a 4-week full-intervention , in which participants received mindful eating training , pre-ordered their lunches , and received price discounts toward lunch purchases . In a 4-week reduced intervention phase , participants pre-ordered lunches without price discounts . Participant lunch purchases were tracked electronically at the point of purchase . The primary outcome measures were the amounts of kilocalories and fat grams in purchased lunches . In contemporaneous comparisons , the treatment group purchased lunches with an average of 144.6 fewer kilocalories ( p = 0.01 ) and 8.9 fewer grams of fat ( p = 0.005 ) compared to controls . In multivariable longitudinal analyses , participants decreased the average number of calories in their meals by 114.6 kcal per lunch and the average grams of fat by 5.4 per lunch during the partial-intervention compared to the baseline ( p < 0.001 ) . At the end of the study , a moderate increase was observed in participants ' overall mindful eating behaviors as compared to the beginning of the study ( p < 0.001 ) . The majority of participants ( 92 % ) said they would use the pre-ordering system if offered in the future . Combined mindful eating training and online pre-ordering appears a feasible and useful worksite intervention to improve food choices by employees BACKGROUND 5 a Day for Better Health is a simple message encouraging people to eat more fruits and vegetables . The Seattle 5 a Day worksite investigators design ed and evaluated an intervention , organized on stages of behavioral change , to increase worksitewide fruit and vegetable consumption . METHODS We recruited 28 worksites with cafeterias and r and omized 14 to intervention and 14 to control . The intervention addressed both changes in the work environment and individual level behavior change . In each worksite , an employee advisory board , with study interventionist assistance , implemented the program . By surveying cross-sectional sample s of 125 employees per worksite , we compared worksite mean fruit and vegetable consumption at 2-year follow-up with that at baseline .  Unobtrusive site-level indicators including plate observation and cafeteria checklist  were also used . RESULTS The difference at 2 years was 0.5 for the intervention worksites and 0.2 for the control worksites , with an intervention effect of 0.3 daily serving ( P < 0.05 ) . Other measures of fruit and vegetable consumption , including unobtrusive indicators , supported the effectiveness of the intervention . CONCLUSIONS This simple 5 a Day intervention is feasible and acceptable for use in worksites with cafeterias . There was a significant differential increase in fruit and vegetable consumption in the intervention worksites . This kind of worksite intervention can achieve important health benefits on a population basis , because of its potential to reach large numbers of people BACKGROUND Preventing obesity requires maintenance of healthy eating behaviors over time . Food labels and strategies that increase visibility and convenience of healthy foods ( choice architecture ) promote healthier choices , but long-term effectiveness is unknown . PURPOSE Assess effectiveness of traffic-light labeling and choice architecture cafeteria intervention over 24 months . DESIGN Longitudinal pre-post cohort follow-up study between December 2009 and February 2012 . Data were analyzed in 2012 . SETTING / PARTICIPANTS Large hospital cafeteria with a mean of 6511 transactions daily . Cafeteria sales were analyzed for ( 1 ) all cafeteria customers and ( 2 ) a longitudinal cohort of 2285 hospital employees who used the cafeteria regularly . INTERVENTION After a 3-month baseline period , cafeteria items were labeled green ( healthy ) ; yellow ( less healthy ) ; or red ( unhealth 
    Output:
    