***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 the authors used an objective assessment of physical function and a range of sociodemographic , dietary , and health behaviors to explore the possible factors that could explain the association between depression and mortality in community-dwelling elderly participants aged 65 years and older . DESIGN prospect i ve follow-up of the National Diet and Nutrition Survey in older adults . SETTING community sample . PARTICIPANTS a total of 1,007 participants ( 522 men , 485 women ; mean age : 76.4 ± 7.3 years ) . MEASUREMENTS : Depression was assessed from the 15 item Geriatric Depression Scale ( GDS ) and physical function using h and grip strength . Participants were followed up for death over an average of 9.2 years . RESULTS : At baseline , 20.9 % of participants demonstrated depression ( GDS-15 score ≥ 5 ) . Depressed participants were at a higher relative risk of all cause mortality during follow-up ( age- and sex-adjusted hazard ratio = 1.24 , 95 % confidence interval : 1.04 - 1.49 ) . Other risk factors for depression also related to mortality included smoking , physical inactivity , and low grip strength . These factors collectively explained an estimated 54 % of the association between depression and mortality . Low- grade inflammation and low plasma vitamin C were also independently associated with depression and mortality but did not explain any of the association between depression and mortality . CONCLUSION late-life depression is associated with a higher risk of mortality . Physical inactivity and physical dysfunction might partly mediate this association , although further longitudinal studies are required to fully eluci date these mechanisms In a prospect i ve study of about 22,000 men attending a screening centre , serum sample s were collected and stored . The concentration of vitamin E ( alpha-tocopherol ) was measured in the stored serum sample s from 271 men subsequently notified as having cancer and from 533 unaffected controls , matched for age , smoking history and duration of storage of the serum sample s. The mean vitamin E level of the cancer subjects was not significantly different from that of their matched controls . The mean level in the cancer  subjects who were diagnosed as having cancer before the elapse of one year from the date of blood collection was , however , significantly lower than the mean concentration of their matched controls ( 10.0 and 11.5 mgl-1 respectively , P = 0.003 ) . For subjects whose cancers were diagnosed one or more years after blood collection the difference was not statistically significant either for all cancers or for cancers of six sites considered separately , viz . lung , colon and rectum , stomach , bladder , central nervous system and skin . The most likely explanation for these results is that the low vitamin E levels observed in these subjects were a metabolic consequence , rather than a precursor , of the cancer . This would explain , at least in part , the overall inverse association between serum vitamin E  and risk of cancer observed in the published epidemiological studies on serum vitamin E and cancer Lycopene is potentially effective in the prevention of breast cancer from laboratory and observational studies . Among 39,876 women initially free of cardiovascular disease and cancer , we first conducted a prospect i ve cohort study of dietary lycopene and its food sources . Participants completed a baseline food frequency question naire and provided self-reports of breast cancer risk factors . Dietary lycopene levels were divided into quintiles , and lycopene food sources were categorized . During 9.9 years of follow-up , 1,076 breast cancer cases were confirmed by medical record review . In a nested case-control study , we then identified 508 breast cancer cases and 508 controls matched by age , smoking , and follow-up time .  Plasma lycopene and other carotenoids were measured . In the prospect i ve cohort study , women with increasing quintiles of dietary lycopene had multivariate relative risks ( RR ) of breast cancer of 1.00 ( ref ) , 0.95 , 1.00 , 1.10 , and 1.00 ( P , linear trend = 0.71 ) . Women consuming < 1.5 , 1.5 to < 4 , 4 to < 7 , 7 to < 10 , and ≥10 servings/week of tomato-based products had RRs of 1.00 ( ref ) , 1.00 , 1.20 , 1.18 , and 1.16 ( P , linear trend = 0.11 ) . No individual lycopene food sources were associated with breast cancer . In the nested case-control study , women in increasing quartiles of plasma lycopene had multivariate RRs of breast cancer of 1.00 ( ref ) , 0.95 , 1.15 , and 0.93 ( P , linear trend = 0.86 ) . The stepwise addition of individual plasma carotenoids did not impact the RRs for plasma lycopene , nor were other carotenoids associated with breast cancer . In conclusion , neither higher dietary nor plasma lycopene levels were associated with a reduced risk of breast cancer in middle-aged and older women In the BUPA Study , a prospect i ve study of 22,000 men attending a screening centre in London , serum sample s were collected and stored . The concentration of  beta-carotene  was measured in the stored serum sample s from 271 men who were subsequently notified as having cancer and from 533 unaffected controls , matched for age , smoking history and duration of storage of the serum sample s. The mean beta-carotene level of the cancer subjects was significantly lower than that of their matched controls ( 198 and 221 micrograms l-1 respectively , P = 0.007 ) . The difference was apparent in subjects from whom blood was collected several years before the diagnosis of the cancer , indicating that the low beta-carotene levels in the cancer subjects were unlikely to have been simply a consequence of pre- clinical disease . Men in the top two quintiles of serum beta-carotene had only about 60 % of the risk of developing cancer compared with men in the bottom quintile . The study was not large enough to be able to indicate with confidence the sites of cancer for which the inverse association between serum beta-carotene and risk of cancer applied , though the association was strongest for lung cancer . The association may be due to beta-carotene affecting the risk directly or it may reflect an indirect association of cancer risk with some other component of vegetables or with a nonvegetable component of diet that is itself related to vegetable consumption Carotenoids are pigments found in fruits and vegetables . While high intakes of fruits and vegetables have been found to be associated with lower mortality , our objective is to investigate if total plasma carotenoids , via their antioxidant properties , are associated with mortality risk in a free-living elderly population . The ' Epidemiology of Vascular Ageing ' ( EVA ) study ( n 1389 ; 59 - 71 years ) is a 9-year longitudinal study with six waves of follow-up . The association between baseline total plasma carotenoids and mortality was determined by Cox proportional hazards regression analyses . Low total plasma carotenoid level was significantly associated with all-cause mortality in men but not in women . After controlling for potential confounding factors , mortality risk increased significantly in men ( P = 0.03 ) with plasma carotenoids in the lowest quintile compared with men with plasma carotenoids in the highest ( relative risk 2.94 ( 95 % CI 1.21 , 7.17 ) ) . A significant association between mortality by cancer and low plasma carotenoid level variable was also found in men ( unit = 1 micromol/l ; relative risk 1.72 ( 95 % CI 1.02 , 2.86 ) ; P = 0.01 ) . Associations between total plasma carotenoids and mortality risk remained statistically significant after taking into account : ( 1 ) plasma Se level , which previously was found associated with mortality in this population and ( 2 ) thiobarbituric acid-reactive substances level considered as an indicator of oxidative stress . By showing , prospect ively , in a general healthy elderly population , that total plasma carotenoid levels were independently associated with mortality risk in men , the present study suggests that total plasma carotenoid levels could be a health indicator in elderly population BACKGROUND Only a few observational studies have related plasma carotene and alpha-tocopherol to mortality in elderly subjects . OBJECTIVE The objective was to study the association of plasma carotene ( alpha- and beta-carotene ) and alpha-tocopherol with all-cause and cause-specific mortality in elderly subjects who participated in a European prospect i ve study . DESIGN Plasma concentrations of carotene and alpha-tocopherol were measured in 1168 elderly men and women . After a follow-up period of 10 y , 388 persons had died . The association between plasma antioxidants and mortality was analyzed by using Cox proportional hazard models . To put our results in context , we performed a meta- analysis of 5 studies on plasma antioxidants and all-cause mortality in elderly population s. RESULTS Plasma carotene concentrations were associated with a lower mortality risk [ adjusted rate ratio ( RR ) for an increment of 0.39 micromol/L : 0.79 ; 95 % CI : 0.70 , 0.89 ] . This lower mortality risk was observed for both cancer ( RR : 0.59 ; 95 % CI : 0.44 , 0.79 ) and cardiovascular disease ( RR : 0.83 ; 95 % CI : 0.70 , 1.00 ) . The lower risk of cardiovascular death was confined to those with a body mass index ( in kg/m2 ) < 25 ( RR : 0.67 ; 95 % CI : 0.49 , 0.94 ) . Plasma concentrations of alpha-tocopherol were not associated with all-cause or cause-specific mortality . The results for both plasma antioxidants and all-cause mortality were confirmed by the meta- analysis . CONCLUSIONS This prospect i ve study suggests that high plasma concentrations of carotene are associated both with lower mortality from all causes and with cancer in the elderly . For cardiovascular mortality , the inverse association was confined to elderly with body mass indexes < 25 BACKGROUND Older persons are at risk of both poor nutrition and increased oxidative stress . Plasma ascorbate concentrations fall with increasing age , and concentrations of other antioxidants may also be reduced . OBJECTIVE The goal was to examine the association between antioxidants and mortality in older persons . DESIGN We r and omly selected persons aged 75 - 84 y from the lists of 51 British family practitioners taking part in a r and omized trial of assessment of older persons . A total of 1214 participants provided a blood sample  and were interviewed about their usual diet with the use of a food-frequency question naire . Statistical analyses were based on deaths after a median of 4.4 y of follow-up , and hazard ratios were estimated for quintiles of dietary or blood antioxidants . RESULTS We found strong inverse trends for blood ascorbate concentrations with all-cause and cardiovascular disease mortality , which were only marginally reduced after adjustment for confounders or supplement use . Those in the lowest fifth ( < 17 micromol/L ) had the highest mortality , whereas those in the highest fifth ( > 66 micromol/L ) had a mortality risk nearly half that ( hazard ratio = 0.54 ; 95 % CI : 0.34 , 0.84 ) . Similar results were found after the exclusion of those subjects with cardiovascular disease or cancer at baseline ( hazard ratio = 0.51 ; 0.28 , 0.93 ) . In fully adjusted models , there was no evidence for an influence of alpha-tocopherol , beta-carotene , or retinol on total mortality .  Dietary antioxidants measured by the food-frequency question naire were not associated with all-cause or cardiovascular disease mortality . CONCLUSION Low blood vitamin C concentrations in the older British population are strongly predictive of mortality BACKGROUND The relation between plasma vitamin C and risk of stroke remains unclear . Although clinical trials showed no significant benefit of vitamin C supplementation in reducing stroke risk , they were not able to examine the relation between plasma vitamin C concentrations and stroke risk in a general population . OBJECTIVE The objective was to examine the relation between baseline plasma vitamin C concentrations and risk of incident stroke in a British population . DESIGN A population -based prospect i ve study was conducted in 20,649 men and women aged 40 - 79 y without prevalent stroke at baseline and participating in the European Prospect i ve Investigation into Cancer-Norfolk prospect i ve population study . The participants completed a health question naire and attended a clinic during 1993 - 1997 and were followed up for incident strokes through March 2005 . RESULTS Over 196,713 total person-years ( average follow-up : 9.5 y ) , 448 incident strokes occurred . In a Cox proportional hazards model , persons in the top quartiles of baseline plasma vitamin C concentrations had a 42 % lower risk ( relative risk : 0.58 ; 95 % CI : 0.43 , 0.78 ) than did those in the bottom quartile , independently of age , sex , smoking , body mass index , systolic blood pressure , cholesterol , physical activity , prevalent diabetes and myocardial infa rct ion , social class , alcohol consumption , and any supplement use . Similar results were obtained after exclusion of persons with illnesses , users of ascorbic acid-containing supplements , and persons with a history of early strokes during the initial 2 y of follow-up . CONCLUSIONS Plasma vitamin C concentrations 
    Output:
    
Dietary intake and /or blood concentrations of carotenoids ( total , β-carotene , α-carotene , β-cryptoxanthin , lycopene ) and α-tocopherol , but not dietary vitamin E , were similarly inversely associated with coronary heart disease , stroke , cardiovascular disease , cancer , and /or all-cause mortality .
Conclusions Higher dietary intake and /or blood concentrations of vitamin C , carotenoids , and α-tocopherol ( as markers of fruit and vegetable intake ) were associated with reduced risk of cardiovascular disease , total cancer , and all-cause mortality .