註釋 OBJECTIVE: We conducted this systematic review to support the U.S. Preventive Services Task Force (USPSTF) in updating its 2012 recommendation on behavioral counseling to promote a healthful diet and physical activity for the primary prevention of cardiovascular disease (CVD) in adults without known CVD risk factors. Our review addressed four key questions: 1. Do primary care behavioral counseling interventions to improve diet, increase physical activity, and/or reduce sedentary behavior improve health outcomes in adults? 2. Do primary care behavioral counseling interventions to improve diet, increase physical activity, and/or reduce sedentary behavior improve intermediate outcomes associated with CVD in adults? 3. Do primary care behavioral counseling interventions to improve diet, increase physical activity, and/or reduce sedentary behavior improve associated health behaviors in adults? 4. What adverse events are associated with primary care behavioral counseling interventions to improve diet, increase physical activity, and/or reduce sedentary behavior in adults? CONCLUSIONS: The results of our updated systematic review are generally consistent in magnitude with our 2010 review on this topic. In general, diet and physical activity behavioral interventions for generally unselected adults who were not targeted for counseling based on their CVD risk resulted in consistent modest benefits across a variety of important intermediate health outcomes, including blood pressure, low-density lipoprotein, and total cholesterol levels as well as adiposity, with evidence of a dose-response effect with higher intensity interventions resulting in greater improvements. Small-to-moderate improvements were also seen in dietary and physical activity behaviors. Very limited evidence exists on health outcomes or harmful effects of these interventions. The improvements we saw, however, in intermediate and behavioral health outcomes could translate into long-term reduction in CVD-related events, with minimal to no harms, if such changes were maintained over time. 