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: BACKGROUND This study tested the efficacy of self-affirmation in promoting fruit and vegetable consumption in a sample of participants comprising two groups at high risk of low consumption : young adults and mothers of school-aged children with low social economic status ( SES ) . METHODS Baseline fruit and vegetable consumption was recorded for 85 participants ( n = 26 mothers with low SES ) . Following r and omisation to condition ( Self-Affirmed or Non-Affirmed ) , participants viewed targeted , online , health recommendations about fruit and vegetable consumption . Fruit and vegetable intake was reported online every day for the following seven days . RESULTS Self-affirmed participants reported consuming significantly more portions of fruit and vegetables ( SA M = 3.96 , NA M = 2.81 ) . Analyses of simple slopes indicated that the effect was greatest amongst lowest baseline consumers . CONCLUSIONS The findings demonstrate the efficacy of  self-affirmation  in increasing fruit and vegetable consumption in individuals who are at risk of having a low intake and whose consumption put them at the greatest risk of negative health outcomes . Application of these findings could help to reduce health care costs , through the use of cost-effective online interventions and reductions in treatment costs . Further research is needed to capitalise on the increased tailoring that online intervention allows in order to optimise the effects of self-affirmation PURPOSE We test the efficacy of an intervention based on the transtheoretical model to increase the intake of fruits and vegetables and to describe differences in psychosocial variables based on the achievement of the 5 A Day Program target . DESIGN AND METHODS This study is a r and omized controlled trial comparing a 12-month fruit and vegetable intervention to a control condition with a 12-month follow-up . Participants included 1,277 community-residing persons who were 60 years of age or older ; 834 provided dietary data at all three time points and are included in our outcome analyses . RESULTS The intervention group increased intake by 0.5 to 1.0 serving more than the control group over 24 months as measured by the NCI Fruit and Vegetable Screener and the 5 A Day Program screener . The majority of the participants ( 58 % ) perceived that they maintained 5 or more servings per day for 24 months . These maintainers had a higher intake at each time point for all dietary measures and differed from those who failed to progress ( 11 % ) for most transtheoretical model variables . IMPLICATION S The intervention was effective in increasing the intake of fruits and vegetables in older adults . Those who maintained their level of perceived intake as 5 or more servings per day consumed 2 - 4 servings per day more than those who failed to progress PURPOSE Anemia is prevalent in old age and is potentially modifiable , but its effects on physical function have not been determined . We examined whether anemia in older persons increases the risk of subsequent decline in physical function , as measured by objective performance-based tests . METHODS Participants in this 4-year prospect i ve cohort study included 1146 participants , aged 71 years or older , living in Iowa and Washington counties , Iowa . Anemia was defined according to World Health Organization ( WHO ) criteria as a hemoglobin concentration below 12 g/dL in women and below 13 g/dL in men . An  assessment of st and ing balance , a timed 2.4-m walk , and a timed test of five chair rises  were used to assess physical performance ; these were combined into a 0 ( poor ) to 12 ( excellent ) summary scale . RESULTS After adjustment for baseline performance score , health status , and demographic characteristics , anemia was associated with greater mean decline in physical performance over 4 years ; the adjusted mean decline was 2.3 ( 95 % confidence interval [ CI ] : 1.7 to 2.8 ) in subjects with anemia and 1.4 ( 95 % CI : 1.2 to 1.5 ) in those without anemia ( P = 0.003 ) . The association between anemia and greater physical decline was also present in participants who were free of diseases associated with anemia ( cancer , infectious disease , and renal failure ) , and after adjustment for serum cholesterol , iron , and albumin levels . Persons with borderline anemia , a hemoglobin concentration within 1 g/dL above the WHO criteria , also showed greater mean physical decline ( 1.8 ; 95 % CI : 1.5 to 2.2 ) than did those with higher hemoglobin concentrations ( P = 0.02 ) . CONCLUSION This study suggests that anemia in old age is an independent risk factor for decline in physical performance BACKGROUND Reducing the intakes of fats and increasing consumption of fruits and vegetables are an important goal for improving population health . Analyzing the effects of nutrition education programs on subjects ' dietary intakes incorporating factors such as habit persistence in diets , unhealthy eating habits , perceptions of health risks , participation motivation , and expectancies can yield useful insights . METHODS A Food Frequency Question naire ( FFQ ) was used to measure intakes at baseline , 6 and 12 months , by 318 and 548 postmenopausal women in , respectively , the Control and Intervention groups of the Women 's Health Trial : Feasibility Study in Minority Population s ( WHTFSMP ) . Information on background , behavioral , and anthropometric variables was collected . The Intervention group met in classes led by nutritionists . Dynamic r and om effects models were estimated for the two groups using the data at baseline , 6 and 12 months on the intakes of carbohydrate , saturated , monounsaturated , and polyunsaturated fats , fiber , beta-carotene , ascorbic acid , and calcium . RESULTS The nutrition education program lowered the intakes of fats while increasing fiber , beta-carotene , and ascorbic acid intakes especially in subjects scoring high on indices reflecting concerns about health , desirability of change , and participation motivation . In addition , subjects '  education was a predictor of dietary intakes in the Intervention group . CONCLUSIONS Nutrition education can be an effective tool for improving diets , but behavioral characteristics deserve greater attention in helping to design the most effective approaches for various target groups Objective : Recent epidemiological and prospect i ve trial evidence suggests that consumption of a low glycaemic index ( LGI ) diet will reduce coronary risk . We hypothesise that introduction of an LGI diet will improve the metabolic profile of patients who have undergone coronary artery bypass grafting . Design : We conducted a r and omised parallel group trial comparing a  control group ( n=29 , age 61.8±9 y ) ,  who received currently advocated healthy eating dietary advice only , to an intervention group , who received healthy eating advice emphasising LGI carbohydrates ( n=26 , age 63.6±9.4 y ) over a 12-week period in free-living patients with coronary heart disease . Outcome measures included fasting glucose , insulin , total cholesterol , high-density lipoprotein cholesterol , very low-density lipoprotein cholesterol , low density lipoprotein cholesterol and triglycerides . Results : A significant lower dietary glycaemic index was achieved in the group assigned to an LGI diet compared to the healthy eating control group ( 71±1 vs 81±1 ) ; fibre intake was also higher in the LGI group ( 20±1 vs 15±1 g ) . All biochemical markers of glucose and lipid metabolism measured were similar after 12 weeks of the LGI diet or control diet . Discussion : The LGI group achieved a significant LGI and a higher dietary fibre intake . However , there was no measurable significant effect of either the LGI diet or the health eating diet on lipid levels ; this may have been hidden by concurrent drug therapy OBJECTIVE To assess the effectiveness of an intervention aim ed to increase adherence to a Mediterranean diet . DESIGN A 12-month assessment of a r and omized primary prevention trial . SUBJECTS/ SETTING S One thous and five hundred fifty-one asymptomatic persons aged 55 to 80 years , with diabetes or > or =3 cardiovascular risk factors . INTERVENTION Participants were r and omly assigned to a control group or two Mediterranean diet groups . Those allocated to the two Mediterranean diet groups received individual motivational interviews every 3 months to negotiate nutrition goals , and group educational sessions on a quarterly basis . One Mediterranean diet group received free virgin olive oil ( 1 L/week ) , the other received free mixed nuts ( 30 g/day ) . Participants in the control group received verbal instructions and a leaflet recommending the National Cholesterol Education Program Adult Treatment Panel III dietary guidelines . MAIN OUTCOME MEASURES Changes in food and nutrient intake after 12 months . STATISTICAL ANALYSES Paired t tests ( for within-group changes ) and analysis of variance ( for between-group changes ) were conducted . RESULTS Participants allocated to both Mediterranean diets increased their intake of virgin olive oil , nuts , vegetables , legumes , and fruits ( P<0.05 for all within- and between-group differences ) . Participants in all three groups decreased their intake of meat and pastries , cakes , and sweets ( P<0.05 for all ) . Fiber , monounsaturated fatty acid , and polyunsaturated fatty acid intake increased in the Mediterranean diet groups ( P<0.005 for all ) . Favorable , although nonsignificant , changes in intake of other nutrients occurred only in the Mediterranean diet groups . CONCLUSIONS A 12-month behavioral intervention promoting the Mediterranean diet can favorably modify an individual 's overall food pattern . The individual motivational interventions together with the group sessions and the free provision of high-fat and palatable key foods customary to the Mediterranean diet were effective in improving the dietary habits of participants in this trial OBJECTIVE To increase fruit , vegetable , and calcium-rich food consumption in community-dwelling , functionally impaired elderly . DESIGN Six-month , home-based nutrition intervention study . SUBJECTS Seventy men and women older than age 69 years were r and omized to either a nutrition education intervention ( n = 38 ) or a control group that received an exercise intervention ( n = 32 ) . INTERVENTION Nutrition education was design ed to increase fruit , vegetable , and calcium-rich food consumption .  MAIN OUTCOME MEASURES Food intake was assessed by a food frequency question naire . Fasting blood measures of nutrients and carotenoids were performed . Statistical Analysis Two-group r and omized controlled trial with pre-test and post-test design and intention-to-treat analysis . Analysis of covariance to was used to assess differences between the two groups . Baseline and change partial correlation coefficients were performed between intake and blood nutrient levels . Paired t tests were conducted to test within-group changes . RESULTS Compared with the exercise group , subjects in nutrition group increased their self-reported intake of fruits by 1.1 + /- 0.2 ( mean + /- SEM ) servings per day ( 2.8 to 3.9 , P = .01 ) , vegetables 1.1 + /- 0.2 servings per day ( 2.3 to 3.4 , P = .001 ) , and milk/dairy 0.9 + /- 0.2 servings per day ( 3.0 to 3.9 , P = .001 ) . There was an increase in the dietary intake of alpha-carotene and beta-carotene in the nutrition group and this correlated with the increase in blood concentrations of alpha-carotene and beta-carotene ( P < or = .02 ; r = 0.33 and r = 0.33 , respectively ) . CONCLUSION The results of this study suggest that it is possible to improve the dietary intake of community dwelling elders to include more fruits , vegetables , and calcium-rich foods . Recommendations for increasing consumption of fruits , vegetables , and calcium-rich foods should be specific and individualized to meet the dietary pattern and lifestyle of the individual . Compliance should be encouraged with record keeping as well as through continuous monitoring and positive reinforcement PURPOSE This study examined the effects of a nutrition education program on self-efficacy , diet behavior pattern and cardiovascular risk factors for patients with cardiovascular disease ( CVD ) . METHOD Sixty-four CVD subjects ( 37 experimental , 27 control ) were recruited from a cardiac center , at a university hospital located in D city , Korea . All subjects attended a first heart camp where pretest measures were performed , and a second heart camp at 6 months for the posttest measures . During the 6 month study period , the experimental group was required to attend five monthly nutrition education sessions , while the control group received only routine outpatient follow-ups . Data were analyzed by chi(2)-test and independent t-test using the SPSSWIN 11.5 program . RESULT Group comparisons revealed that the experimental group had significantly more improved self-efficacy , frequency of food selection , gustation of salt , systolic blood pressure , and serum total-cholesterol compared to the control group . CONCLUSION A nutrition education program may be effective in improving self-efficacy , diet behavior pattern and cardiovascular risk factors for patients with cardiovascular disease Objective The objective of this paper was to discuss the impact of a two-year food aid intervention programme on dietary diversity and adequacy of an elderly community . This project was undertaken amongst the elderly ( n=300 ) , voluntarily attending a day care centre in Sharpeville , South Africa . In a baseline study ( 2004 ) in this community the dietary diversity scoring 
    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: BACKGROUND This study tested the efficacy of self-affirmation in promoting fruit and vegetable consumption in a sample of participants comprising two groups at high risk of low consumption : young adults and mothers of school-aged children with low social economic status ( SES ) . METHODS Baseline fruit and vegetable consumption was recorded for 85 participants ( n = 26 mothers with low SES ) . Following r and omisation to condition ( Self-Affirmed or Non-Affirmed ) , participants viewed targeted , online , health recommendations about fruit and vegetable consumption . Fruit and vegetable intake was reported online every day for the following seven days . RESULTS Self-affirmed participants reported consuming significantly more portions of fruit and vegetables ( SA M = 3.96 , NA M = 2.81 ) . Analyses of simple slopes indicated that the effect was greatest amongst lowest baseline consumers . CONCLUSIONS The findings demonstrate the efficacy of  self-affirmation  in increasing fruit and vegetable consumption in individuals who are at risk of having a low intake and whose consumption put them at the greatest risk of negative health outcomes . Application of these findings could help to reduce health care costs , through the use of cost-effective online interventions and reductions in treatment costs . Further research is needed to capitalise on the increased tailoring that online intervention allows in order to optimise the effects of self-affirmation PURPOSE We test the efficacy of an intervention based on the transtheoretical model to increase the intake of fruits and vegetables and to describe differences in psychosocial variables based on the achievement of the 5 A Day Program target . DESIGN AND METHODS This study is a r and omized controlled trial comparing a 12-month fruit and vegetable intervention to a control condition with a 12-month follow-up . Participants included 1,277 community-residing persons who were 60 years of age or older ; 834 provided dietary data at all three time points and are included in our outcome analyses . RESULTS The intervention group increased intake by 0.5 to 1.0 serving more than the control group over 24 months as measured by the NCI Fruit and Vegetable Screener and the 5 A Day Program screener . The majority of the participants ( 58 % ) perceived that they maintained 5 or more servings per day for 24 months . These maintainers had a higher intake at each time point for all dietary measures and differed from those who failed to progress ( 11 % ) for most transtheoretical model variables . IMPLICATION S The intervention was effective in increasing the intake of fruits and vegetables in older adults . Those who maintained their level of perceived intake as 5 or more servings per day consumed 2 - 4 servings per day more than those who failed to progress PURPOSE Anemia is prevalent in old age and is potentially modifiable , but its effects on physical function have not been determined . We examined whether anemia in older persons increases the risk of subsequent decline in physical function , as measured by objective performance-based tests . METHODS Participants in this 4-year prospect i ve cohort study included 1146 participants , aged 71 years or older , living in Iowa and Washington counties , Iowa . Anemia was defined according to World Health Organization ( WHO ) criteria as a hemoglobin concentration below 12 g/dL in women and below 13 g/dL in men . An  assessment of st and ing balance , a timed 2.4-m walk , and a timed test of five chair rises  were used to assess physical performance ; these were combined into a 0 ( poor ) to 12 ( excellent ) summary scale . RESULTS After adjustment for baseline performance score , health status , and demographic characteristics , anemia was associated with greater mean decline in physical performance over 4 years ; the adjusted mean decline was 2.3 ( 95 % confidence interval [ CI ] : 1.7 to 2.8 ) in subjects with anemia and 1.4 ( 95 % CI : 1.2 to 1.5 ) in those without anemia ( P = 0.003 ) . The association between anemia and greater physical decline was also present in participants who were free of diseases associated with anemia ( cancer , infectious disease , and renal failure ) , and after adjustment for serum cholesterol , iron , and albumin levels . Persons with borderline anemia , a hemoglobin concentration within 1 g/dL above the WHO criteria , also showed greater mean physical decline ( 1.8 ; 95 % CI : 1.5 to 2.2 ) than did those with higher hemoglobin concentrations ( P = 0.02 ) . CONCLUSION This study suggests that anemia in old age is an independent risk factor for decline in physical performance BACKGROUND Reducing the intakes of fats and increasing consumption of fruits and vegetables are an important goal for improving population health . Analyzing the effects of nutrition education programs on subjects ' dietary intakes incorporating factors such as habit persistence in diets , unhealthy eating habits , perceptions of health risks , participation motivation , and expectancies can yield useful insights . METHODS A Food Frequency Question naire ( FFQ ) was used to measure intakes at baseline , 6 and 12 months , by 318 and 548 postmenopausal women in , respectively , the Control and Intervention groups of the Women 's Health Trial : Feasibility Study in Minority Population s ( WHTFSMP ) . Information on background , behavioral , and anthropometric variables was collected . The Intervention group met in classes led by nutritionists . Dynamic r and om effects models were estimated for the two groups using the data at baseline , 6 and 12 months on the intakes of carbohydrate , saturated , monounsaturated , and polyunsaturated fats , fiber , beta-carotene , ascorbic acid , and calcium . RESULTS The nutrition education program lowered the intakes of fats while increasing fiber , beta-carotene , and ascorbic acid intakes especially in subjects scoring high on indices reflecting concerns about health , desirability of change , and participation motivation . In addition , subjects '  education was a predictor of dietary intakes in the Intervention group . CONCLUSIONS Nutrition education can be an effective tool for improving diets , but behavioral characteristics deserve greater attention in helping to design the most effective approaches for various target groups Objective : Recent epidemiological and prospect i ve trial evidence suggests that consumption of a low glycaemic index ( LGI ) diet will reduce coronary risk . We hypothesise that introduction of an LGI diet will improve the metabolic profile of patients who have undergone coronary artery bypass grafting . Design : We conducted a r and omised parallel group trial comparing a  control group ( n=29 , age 61.8±9 y ) ,  who received currently advocated healthy eating dietary advice only , to an intervention group , who received healthy eating advice emphasising LGI carbohydrates ( n=26 , age 63.6±9.4 y ) over a 12-week period in free-living patients with coronary heart disease . Outcome measures included fasting glucose , insulin , total cholesterol , high-density lipoprotein cholesterol , very low-density lipoprotein cholesterol , low density lipoprotein cholesterol and triglycerides . Results : A significant lower dietary glycaemic index was achieved in the group assigned to an LGI diet compared to the healthy eating control group ( 71±1 vs 81±1 ) ; fibre intake was also higher in the LGI group ( 20±1 vs 15±1 g ) . All biochemical markers of glucose and lipid metabolism measured were similar after 12 weeks of the LGI diet or control diet . Discussion : The LGI group achieved a significant LGI and a higher dietary fibre intake . However , there was no measurable significant effect of either the LGI diet or the health eating diet on lipid levels ; this may have been hidden by concurrent drug therapy OBJECTIVE To assess the effectiveness of an intervention aim ed to increase adherence to a Mediterranean diet . DESIGN A 12-month assessment of a r and omized primary prevention trial . SUBJECTS/ SETTING S One thous and five hundred fifty-one asymptomatic persons aged 55 to 80 years , with diabetes or > or =3 cardiovascular risk factors . INTERVENTION Participants were r and omly assigned to a control group or two Mediterranean diet groups . Those allocated to the two Mediterranean diet groups received individual motivational interviews every 3 months to negotiate nutrition goals , and group educational sessions on a quarterly basis . One Mediterranean diet group received free virgin olive oil ( 1 L/week ) , the other received free mixed nuts ( 30 g/day ) . Participants in the control group received verbal instructions and a leaflet recommending the National Cholesterol Education Program Adult Treatment Panel III dietary guidelines . MAIN OUTCOME MEASURES Changes in food and nutrient intake after 12 months . STATISTICAL ANALYSES Paired t tests ( for within-group changes ) and analysis of variance ( for between-group changes ) were conducted . RESULTS Participants allocated to both Mediterranean diets increased their intake of virgin olive oil , nuts , vegetables , legumes , and fruits ( P<0.05 for all within- and between-group differences ) . Participants in all three groups decreased their intake of meat and pastries , cakes , and sweets ( P<0.05 for all ) . Fiber , monounsaturated fatty acid , and polyunsaturated fatty acid intake increased in the Mediterranean diet groups ( P<0.005 for all ) . Favorable , although nonsignificant , changes in intake of other nutrients occurred only in the Mediterranean diet groups . CONCLUSIONS A 12-month behavioral intervention promoting the Mediterranean diet can favorably modify an individual 's overall food pattern . The individual motivational interventions together with the group sessions and the free provision of high-fat and palatable key foods customary to the Mediterranean diet were effective in improving the dietary habits of participants in this trial OBJECTIVE To increase fruit , vegetable , and calcium-rich food consumption in community-dwelling , functionally impaired elderly . DESIGN Six-month , home-based nutrition intervention study . SUBJECTS Seventy men and women older than age 69 years were r and omized to either a nutrition education intervention ( n = 38 ) or a control group that received an exercise intervention ( n = 32 ) . INTERVENTION Nutrition education was design ed to increase fruit , vegetable , and calcium-rich food consumption .  MAIN OUTCOME MEASURES Food intake was assessed by a food frequency question naire . Fasting blood measures of nutrients and carotenoids were performed . Statistical Analysis Two-group r and omized controlled trial with pre-test and post-test design and intention-to-treat analysis . Analysis of covariance to was used to assess differences between the two groups . Baseline and change partial correlation coefficients were performed between intake and blood nutrient levels . Paired t tests were conducted to test within-group changes . RESULTS Compared with the exercise group , subjects in nutrition group increased their self-reported intake of fruits by 1.1 + /- 0.2 ( mean + /- SEM ) servings per day ( 2.8 to 3.9 , P = .01 ) , vegetables 1.1 + /- 0.2 servings per day ( 2.3 to 3.4 , P = .001 ) , and milk/dairy 0.9 + /- 0.2 servings per day ( 3.0 to 3.9 , P = .001 ) . There was an increase in the dietary intake of alpha-carotene and beta-carotene in the nutrition group and this correlated with the increase in blood concentrations of alpha-carotene and beta-carotene ( P < or = .02 ; r = 0.33 and r = 0.33 , respectively ) . CONCLUSION The results of this study suggest that it is possible to improve the dietary intake of community dwelling elders to include more fruits , vegetables , and calcium-rich foods . Recommendations for increasing consumption of fruits , vegetables , and calcium-rich foods should be specific and individualized to meet the dietary pattern and lifestyle of the individual . Compliance should be encouraged with record keeping as well as through continuous monitoring and positive reinforcement PURPOSE This study examined the effects of a nutrition education program on self-efficacy , diet behavior pattern and cardiovascular risk factors for patients with cardiovascular disease ( CVD ) . METHOD Sixty-four CVD subjects ( 37 experimental , 27 control ) were recruited from a cardiac center , at a university hospital located in D city , Korea . All subjects attended a first heart camp where pretest measures were performed , and a second heart camp at 6 months for the posttest measures . During the 6 month study period , the experimental group was required to attend five monthly nutrition education sessions , while the control group received only routine outpatient follow-ups . Data were analyzed by chi(2)-test and independent t-test using the SPSSWIN 11.5 program . RESULT Group comparisons revealed that the experimental group had significantly more improved self-efficacy , frequency of food selection , gustation of salt , systolic blood pressure , and serum total-cholesterol compared to the control group . CONCLUSION A nutrition education program may be effective in improving self-efficacy , diet behavior pattern and cardiovascular risk factors for patients with cardiovascular disease Objective The objective of this paper was to discuss the impact of a two-year food aid intervention programme on dietary diversity and adequacy of an elderly community . This project was undertaken amongst the elderly ( n=300 ) , voluntarily attending a day care centre in Sharpeville , South Africa . In a baseline study ( 2004 ) in this community the dietary diversity scoring 
    Output:
    