The DOI matches its Crossref record; 399 of the 404 references it cites were found in a registry or an index; none of the 15 sources its claims cite is checked for support yet.
Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Cardiovascular Disease Risk Factors: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force
Open accessAbstract
IMPORTANCE: Unhealthful dietary patterns, low levels of physical activity, and high sedentary time increase the risk of cardiovascular disease. OBJECTIVE: To systematically review the evidence on the benefits and harms of behavioral counseling for the primary prevention of cardiovascular disease in adults without known cardiovascular risk factors to inform the US Preventive Services Task Force. DATA SOURCES: MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, and PsycINFO for studies published in the English language between January 1, 2013, and May 25, 2016, and ongoing surveillance in targeted publications through March 24, 2017. Studies included in the previous review were reevaluated for inclusion. STUDY SELECTION: Randomized clinical trials of behavioral interventions targeting improved diet, increased physical activity, decreased sedentary time, or a combination of these among adults without known hypertension, dyslipidemia, diabetes, or impaired fasting glucose. DATA EXTRACTION AND SYNTHESIS: Independent critical appraisal and data abstraction by 2 reviewers. MAIN OUTCOMES AND MEASURES: Cardiometabolic health and intermediate outcomes, behavioral outcomes, and harms related to interventions. RESULTS: Eighty-eight studies (N = 121 190) in 145 publications were included. There was no consistent benefit of the interventions on all-cause or cardiovascular mortality or morbidity (4 trials [n = 51 356]) or health-related quality of life (10 trials [n = 52 423]). There was evidence of small, statistically significant between-group mean differences for systolic blood pressure (-1.26 mm Hg [95% CI, -1.77 to -0.75]; 22 trials [n = 57 953]), diastolic blood pressure (-0.49 mm Hg [95% CI, -0.82 to -0.16]; 23 trials [n = 58 022]), low-density lipoprotein cholesterol level (-2.58 mg/dL [95% CI, -4.30 to -0.85]; 13 trials [n = 5554]), total cholesterol level (-2.85 mg/dL [95% CI, -4.95 to -0.75]; 19 trials [n = 9325]), and body mass index (-0.41 [95% CI, -0.62 to -0.19]; 20 trials [n = 55 059]) at 6 to 12 months as well as small-to-modest associations with dietary and physical activity behaviors. There was no evidence of greater incidence of serious adverse events, injuries, or falls in intervention vs control participants. CONCLUSIONS AND RELEVANCE: Diet and physical activity behavioral interventions for adults not at high risk for cardiovascular disease result in consistent modest benefits across a variety of important intermediate health outcomes across 6 to 12 months, including blood pressure, low-density lipoprotein and total cholesterol levels, and adiposity, with evidence of a dose-response effect, with higher-intensity interventions conferring greater improvements. There is very limited evidence on longer-term intermediate and health outcomes or on harmful effects of these interventions.
Overview
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Written from the paper’s full text.
TL;DR
This updated systematic review for the USPSTF found that behavioral counseling interventions promoting healthful diet and physical activity in adults without known cardiovascular disease risk factors produce small, statistically significant improvements in intermediate cardiometabolic outcomes at 6 to 12 months, with a dose-response effect by intervention intensity. Evidence on mortality, cardiovascular morbidity, quality of life, longer-term outcomes, and harms was limited or inconsistent.
Key findings
- Across 88 studies (N=121,190) in 145 publications, there was no consistent benefit of the interventions on all-cause or cardiovascular mortality or morbidity (4 trials, N=51,356) or health-related quality of life (10 trials, N=52,423).
- Pooled between-group mean differences at 6 to 12 months favored intervention for systolic blood pressure (−1.26 mm Hg [95% CI, −1.77 to −0.75]; 22 trials, N=57,953), diastolic blood pressure (−0.49 mm Hg [95% CI, −0.82 to −0.16]; 23 trials, N=58,022), LDL cholesterol (−2.58 mg/dL [95% CI, −4.30 to −0.85]; 13 trials, N=5,554), total cholesterol (−2.85 mg/dL [95% CI, −4.95 to −0.75]; 19 trials, N=9,325), and BMI (−0.41 kg/m2 [95% CI, −0.62 to −0.19]; 20 trials, N=55,059).
- Physical activity interventions were associated with a 35-minute increase in physical activity per week versus controls (95% CI, 22.0 to 47.0; 27 trials) and an odds ratio of 1.32 for meeting physical activity recommendations (95% CI, 1.12 to 1.56; 16 trials); dietary effects were variable.
- There was no evidence of greater incidence of serious adverse events, injuries, or falls in intervention versus control participants, and higher-intensity interventions were associated with greater improvements in intermediate outcomes.
Methods
- Systematic review for the US Preventive Services Task Force; searched MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, and PsycINFO for English-language studies published January 1, 2013 to May 25, 2016, with ongoing surveillance through January 20, 2017; studies from the previous review were re-evaluated.
- Included randomized clinical trials of primary care-relevant behavioral interventions targeting improved diet, increased physical activity, decreased sedentary time, or a combination among adults without known hypertension, dyslipidemia, diabetes, or impaired fasting glucose; 88 studies (N=121,190) in 145 publications were included.
- Two reviewers independently appraised and abstracted data; random-effects meta-analyses using the DerSimonian and Laird method were run for intermediate and behavioral outcomes, while health outcomes and adverse events were summarized descriptively; intervention intensity was categorized as low (≤30 minutes), medium (31–360 minutes), or high (>360 minutes).
Limitations
- The paper states that complex interventions are difficult to describe and synthesize, that better reporting is needed (e.g., TIDieR, RE-AIM, PRECIS), that message-focus analyses were highly confounded by intervention intensity, that only one study targeted sedentary behavior as the main focus and only three reported sedentary outcomes, and that few studies explored subpopulation effects.
- The paper states that most trials relied on self-reported dietary and physical activity measures with variable reliability and validity, and that heterogeneous studies were intentionally pooled, so interpreting 95% confidence intervals rather than the summary estimate helps inform the true magnitude of effects.
- Evident from the text: evidence on longer-term (>12 months) intermediate and health outcomes was very limited, and harms were sparsely and inconsistently reported, with no serious adverse events found but limited data.
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0 of 15 cited sources checked · 0 supported · 0 flagged
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Eighty-eight studies (N=121190) in 145 publications were included.”
- Also stated in: § RESULTS · plain
“A total of 10045 titles and abstracts and 351 articles were reviewed to determine if they met the pre-specified inclusion criteria and 88 trials (87 RCTs [n = 121106] and 1 nonrandomized clinical trial [n=84]) reported in 145 publications were included”
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Ten trials reported quality of life outcomes and reported modest improvements at 6 and 12 months among intervention participants, but no consistent benefit of the intervention compared with control conditions.”
Strength:plain· not yet calibratedn = 52,423Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was no consistent benefit of the interventions on all-cause or cardiovascular mortality or morbidity (4 trials, N=51356)”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“weight (MD, −1.04 kg [95% CI, −1.56 to −0.51])”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“There is very limited evidence on longer-term intermediate and health outcomes, or harmful effects of these interventions.”
- Also stated in: § Conclusions · plain
“There is very limited evidence on longer-term intermediate and health outcomes, or harmful effects of these interventions.”
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § Conclusions · plain
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In the paper
“as well as small-to-modest associations with dietary and physical activity behaviors”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIn the paper
“or fatal and nonfatal stroke (adjusted HR, 1.02 [95% CI 0.90 to 1.17]) among women without a history of CVD between those randomized to low-fat diet counseling and those in a usual care diet group over 8.1 years of follow-up.”
What the sources say
- Not checked yetcites [82] Howard BV, Van HL, Hsia J, et al. Low-fat dietary pattern and risk of cardiovascular disease: the Women's Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. 2006;295(6):655–666. [DOI] [PubMed] [Google Scholar]
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIn the paper
“long-term observational follow-up from the Trial of Hypertension Prevention (TOHP) phase I and II (n = 2415) showed a significant difference in CVD (defined as MI, stroke, revascularization, or CVD death) between treatment groups over 10 to 15 years of follow-up (HR, 0.70 [95% CI, 0.53 to 0.94]).”
What the sources say
- Not checked yetcites [49] Cook NR, Cutler JA, Obarzanek E, et al. Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP). BMJ. 2007;334(7599):885–888. [DOI] [PMC free article] [PubMed] [Google Scholar]
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was no evidence of greater incidence of serious adverse events, injuries or falls in intervention versus control participants.”
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“waist circumference (MD, −1.19 centimeters [cm] [95% CI, −1.79 to −0.59])”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
- The quote only partly states this claim. 11
- Probably not a substantial claim. 13
- It may state two separate claims as one. 15
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“−0.49 mm Hg (95% CI, −0.82 to −0.16) for DBP”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe quote only partly states this claim.
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In the paper
“−2.85 mg/dL (95% CI, −4.95 to −0.75) for total cholesterol”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was evidence of small, statistically significant between-group mean differences for systolic blood pressure (−1.26 mm Hg [95% confidence interval (CI), −1.77 to −0.75], 22 trials, N=57953)”
- Also stated in: § RESULTS · plain
“Pooled between-group mean differences (MD) were: −1.26 mm Hg (95% CI, −1.77 to −0.75) for SBP”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe quote only partly states this claim.
- Also stated in: § RESULTS · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“−2.58 mg/dL (95% CI, −4.30 to −0.85) for LDL cholesterol”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Twelve of the 88 included trials reported health outcomes.”
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
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In the paper
“Overall, few deaths were reported and no differences were observed between treatment and control groups over 3 to 15 years followup.”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Four trials (n = 51356) reported all-cause or CVD-related mortality83,147,148,152 of which 3 also reported cardiovascular events.147,148,152”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Thirty-four of the included trials (n = 75793) reported the effects of behavioral interventions on at least 1 intermediate outcome (i.e., blood pressure, lipid levels, glucose levels, or adiposity measures); nearly half of the trials were of good quality.”
Strength:plain· not yet calibratedn = 75,793Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The 3 trials that reported cardiovascular events or composite CVD outcomes showed some beneficial results, although results were mixed.”
Strength:plain· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
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In the paper
“with considerable statistical heterogeneity (I2>90%) in all analyses”
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesThe quote only partly states this claim.
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In the paper
“The last surveillance was conducted on January 20, 2017, and identified no new studies.”
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The associations between medium-intensity interventions (5 to 9 trials per outcome) and intermediate outcomes were less consistent and generally showed no benefit, with the exception of the outcome of weight.”
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
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In the paper
“Very few trials reported longer-term effects (i.e., greater than 12 months follow-up) on intermediate outcomes and there was no consistent pattern in the effects over time among those that did.”
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In the paper
“Harms of included interventions were sparsely reported and were inconsistently defined.”
Strength:plain· not yet calibratedn = 8,220Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The pooled estimates found in this updated systematic review were generally consistent in magnitude with the 2010 review on this topic,15 and slightly lower in magnitude compared with the associations seen in the 2014 review among persons at high risk for CVD14 (eTable 3 in the Supplement).”
What the sources say
- Not checked yetcites [15] Lin JS, O'Connor E, Whitlock EP, et al. Behavioral counseling to promote physical activity and a healthful diet to prevent cardiovascular disease in adults: update of the evidence for the U.S. Preventive Services Task Force. Evidence Synthesis No. 79. AHRQ Publication No. 11–05149-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; Dec 2010. [PubMed] [Google Scholar]
- Not checked yetcites [14] Lin JS, O'Connor EA, Evans CV, Senger CA, Rowland MG, Groom HC. Behavioral counseling to promote a healthy lifestyle for cardiovascular disease prevention in persons with cardiovascular risk factors: an updated systematic evidence review for the U.S. Preventive Services Task Force. Evidence Report No. 113. AHRQ Publication No. 13–05179-EF-1. Rockville MD: Agency for Healthcare Research and Quality; 2014. [PubMed] [Google Scholar]
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“DBP, mm Hg −0.49 (−0.82, −0.16) 23 37.9”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“SBP, mm Hg −1.26 (−1.77, −0.75) 22 44.5”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe quote only partly states this claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Data on physical activity outcomes beyond 12 months was sparsely reported.”
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
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In the paper
“Only 9 trials reported the effects of the interventions on dietary outcomes at greater than 12 months follow-up (i.e., 1.5 to 6 years follow-up) with a lack of effect or slightly attenuated effect being seen over time.”
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
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In the paper
“Low-density lipoprotein cholesterol, mg/dL a −2.58 (−4.30, −0.85) 13 19.6”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe quote only partly states this claim.
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In the paper
“Total cholesterol, mg/dL a −2.85 (−4.95, −0.75) 19 50.8”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe quote only partly states this claim.
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In the paper
“BMI, kg/m2 −0.41 (−0.62, −0.19) 20 95.8”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Also, only one of the included studies targeted reductions in sedentary behavior (i.e., sitting time) as the main focus of the trial and only three trials reported the outcomes of sedentary behavior.”
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
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In the paper
“Waist circumference, cm e −1.19 (−1.79, −0.59) 17 91.8”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This review found no evidence of a difference in effects by the focus of the message, but analyses were highly confounded by the intensity of interventions.”
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
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In the paper
“One reviewer completed primary data abstraction and a second reviewer checked all data for accuracy and completeness.”
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
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In the paper
“Studies were rated as poor quality and excluded if they had several important major risks of bias, including: very high attrition at 6–12 months (e.g., greater than 40%), differential attrition between intervention groups (e.g., greater than 20%), lack of baseline comparability between groups without adjustment for those variables, or other issues in the conduct, analysis, or reporting of results”
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In the paper
“Two reviewers independently assessed the methodological quality of all eligible studies, by using criteria outlined by the USPSTF”
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In the paper
“Statistical heterogeneity among the pooled studies was examined using standard χ2 tests and the proportion of total variability in point estimates was approximated using the I2 statistic.”
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In the paper
“Two reviewers independently reviewed all identified titles and abstracts and relevant full-text articles against pre-specified inclusion and exclusion criteria”
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In the paper
“The data on health outcomes (KQ1) and adverse events (KQ4) did not allow for pooled analyses, so were summarized descriptively.”
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In the paper
“In order to evaluate small-study effects, funnel plots, and the Egger test19 (for continuous outcomes) or Peters test20 (for dichotomous outcomes) were examined.”
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In the paper
“The strength of the overall body of evidence for each key question was graded as high, moderate, low, or insufficient based on established methods21 and addressed the consistency, precision, reporting bias, study quality, and dose-response related to each outcome.”
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In the paper
“Consistent rules were used to estimate the total minutes of contact and to categorize each intervention group by intensity.”
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Each of these methods can be prone to bias.177”
What the sources say
- Not checked yetcites [177] Newell SA, Girgis A, Sanson-Fisher RW, Savolainen NJ. The accuracy of self-reported health behaviors and risk factors relating to cancer and cardiovascular disease in the general population: a critical review. Am J Prev Med. 1999;17(3):211–229. [DOI] [PubMed] [Google Scholar]
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“For most outcomes, the statistical heterogeneity of pooled analyses was unimportant (I2<40%) or moderate (I2=30% to 60%) and therefore still reasonable to allow for interpreting of pooled estimates.”
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper relies on this without support.
The absence of reported serious adverse events in the trials that reported harms indicates that serious harms are unlikely across all included interventions.
“Harms of included interventions were sparsely reported and were inconsistently defined.”
“there is moderate confidence that there are no serious harms related to behavioral counseling interventions for healthful diet and physical activity.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The use of structured lifestyle interventions is reported to be effective in increasing physical activity participation and reducing the progression of chronic diseases [10-12].”
From Consumer-based wearable activity trackers increase physical activity participation: systematic review and meta-analysis (2019) · cites this paper as [11]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“We also found a significantly decreased waist circumference with the same magnitude (− 1.19 cm; 95% CI: [− 1.79, − 0.59] cm) as found in another published meta-analysis in which the effect of physical activity and dietery interventions on waist circumference was evaluated [11].”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Weight estimate is not centered in its reported confidence interval
MinorFor the low-intensity weight result, the midpoint of the reported confidence interval is −0.58 kg, not the reported mean difference of −0.23 kg. This is inconsistent with the symmetric confidence intervals used for the mean differences in the table.
Reported -0.23 · recomputed -0.58
“−0.23 (−1.56, 0.40) 2 0”
Two different upper confidence limits for the physical-activity odds ratio
MinorThe narrative gives an upper 95% confidence limit of 1.56 for the odds of meeting physical activity recommendations, while Table 3 gives 1.64 for the same odds ratio and lower limit.
“intervention group participants had an odds ratio of 1.32 (95% CI, 1.12 to 1.56) for meeting physical activity recommendations”
“Significantly higher odds of meeting PA recommendations (150 min/week of PA) among intervention vs. control group participants (OR: 1.32 [95% CI, 1.12 to 1.64], k=16).”
Sedentary-behavior trial count changes from four to three
MinorThe results state that four trials reported sedentary-behavior measures, whereas the limitations section says only three trials reported sedentary-behavior outcomes.
“Only four trials reported measures of sedentary behavior independent of physical activity behavior.”
“only three trials reported the outcomes of sedentary behavior.”
Citations
Cites
3 retracted
RETRACTED: Primary Prevention of Cardiovascular Disease with a Mediterranean Diet
Estruch, R., Ros, E., Salas-Salvadó, J., Covas, M.-I., Corella, D., Arós, F., Gómez-Gracia, E., Ruiz-Gutiérrez, V., Fiol, M., Lapetra, J., et al. (2013) · New England Journal of Medicine · doi:10.1056/nejmoa1200303 · Cited by 4,257
RetractedEstruch, R., Martínez‐González, M. Á., Corella, D., Salas‐Salvadó, J., Fitó, M., Chiva‐Blanch, G., Fiol, M., Gómez‐Gracia, E., Arós, F., Lapetra, J., et al. (2016) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(16)30085-7 · Cited by 200
RetractedEstruch, R., Martínez-González, M. A., Corella, D., Salas-Salvadó, J., Fitó, M., Chiva-Blanch, G., Fiol, M., Gómez-Gracia, E., Arós, F., Lapetra, J., et al. (2019) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(19)30074-9 · Cited by 147
RetractedBias in meta-analysis detected by a simple, graphical test
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Meta-analysis in clinical trials
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Flagged first, then by citations
5 of the 404 references couldn’t be matched to a known paper.
Research works printed but not linked: 10
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Cited by
Sorted by citations
Items 101–101 of 101
Tang, T. S., Sidhu, R., Halani, K., Elliott, T., Sohal, P., & Garg, A. (2022) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2021.11.003 · Cited by 7
Metadata
- Authors
- Patnode, C. D., Evans, C. V., Senger, C. A., Redmond, N., & Lin, J. S.
- Affiliations
- Kaiser Permanente (US)
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
- Corresponding author
- Patnode, Carrie D.
- ORCID
- Lin, Jennifer S.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2017-07-11
- Volume
- 318
- Issue
- 2
- Pages
- 175
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC13292382
- OpenAlex
- W2734860524
- Cited by
- 380
- References
- 404
- Citations by year
- 2026: 7 · 2025: 25 · 2024: 31 · 2023: 33 · 2022: 49 · 2021: 61 · 2020: 108 · 2019: 39 · 2018: 21 · 2017: 6
- FWCI
- 44.61
- Type
- journal article
- Language
- en
- Open access
- green
- pmc.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Keywords
- behavioral counseling, cardiovascular disease prevention, primary prevention, healthy eating, physical activity, sedentary time, cardiometabolic health, systolic blood pressure, LDL cholesterol, total cholesterol, body mass index, health-related quality of life, cardiovascular mortality, cardiovascular morbidity, harms of interventions, USPSTF recommendations, physical activity counseling, smoking cessation
- MeSH terms
- Diet, Healthy, Counseling, Humans, Preventive Health Services, Risk Factors, United States, Health Behavior, Exercise, Randomized Controlled Trials as Topic, Advisory Committees
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-09, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-09 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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