***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 
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    Input: Background A few observational studies have found an inverse association between adherence to a  Mediterranean diet and the risk of depression .  R and omized trials with an intervention based on this dietary pattern could provide the most definitive answer to the findings reported by observational studies . The aim of this study was to compare in a r and omized trial the effects of two Mediterranean diets versus a low-fat diet on depression risk after at least 3 years of intervention . Methods This was a multicenter , r and omized , primary prevention field trial of cardiovascular disease ( Prevención con Dieta Mediterránea ( PREDIMED Study ) ) based on community-dwelling men aged 55 to 80 years and women aged 60 to 80 years at high risk of cardiovascular disease ( 51 % of them had type 2 diabetes ; DM2 ) attending primary care centers affiliated with 11 Spanish teaching hospitals . Primary analyses were performed on an intention-to-treat basis . Cox regression models were used to assess the relationship between the nutritional intervention groups and the incidence of depression . Results We identified 224 new cases of depression during follow-up . There was an inverse association with depression for participants assigned to a Mediterranean diet supplemented with nuts ( multivariate hazard ratio ( HR ) 0.78 ; 95 % confidence interval ( CI ) 0.55 to 1.10 ) compared with participants assigned to the control group , although this was not significant . However , when the analysis was restricted to participants with DM2 , the magnitude of the effect of the intervention with the Mediterranean diet supplemented with nuts did reach statistical significance ( multivariate HR = 0.59 ; 95 % CI 0.36 to 0.98 ) . Conclusions The result suggest that a Mediterranean diet supplemented with nuts could exert a beneficial effect on the risk of depression in patients with DM2.Trial registration This trial has been registered in the Current Controlled Trials with the number IS RCT N BACKGROUND Although individual nutrients have been investigated in relation to depression risk , little is known about the overall role of diet in depression . OBJECTIVE We examined whether long-term dietary patterns derived from a food-frequency question naire ( FFQ ) predict the development of depression in middle-aged and older women . DESIGN We conducted a prospect i ve study in 50,605 participants ( age range : 50 - 77 y ) without depression in the Nurses ' Health Study at baseline ( 1996 ) who were followed until 2008 .  Long-term diet  was assessed by using  FFQs every 4 y since 1986 . Prudent ( high in vegetables ) and Western ( high in meats ) patterns were identified by using a principal component analysis . We used 2 definitions for clinical depression as follows : a strict definition that required both a reported clinical diagnosis and use of antidepressants ( 3002 incident cases ) and a broad definition that further included women who reported either a clinical diagnosis or antidepressant use ( 7413 incident cases ) . RESULTS After adjustment for age , body mass index , and other potential confounders , no significant association was shown between the diet patterns and depression risk under the strict definition . Under the broad definition , women with the highest scores for the Western pattern had 15 % higher risk of depression ( 95 % CI : 1.04 , 1.27 ; P-trend = 0.01 ) than did women with the lowest scores , but after additional adjustment for psychological scores at baseline , results were no longer significant ( RR : 1.09 ; 95 % CI : 0.99 , 1.21 ; P-trend = 0.08 ) . CONCLUSION Overall , results of this large prospect i ve study do not support a clear association between  dietary patterns  from factor analysis and depression risk BACKGROUND Studies of diet and depression have focused primarily on individual nutrients . AIMS To examine the association between dietary patterns and depression using an overall diet approach . METHOD Analyses were carried on data from 3486 participants ( 26.2 % women , mean age 55.6 years ) from the Whitehall II prospect i ve cohort , in which two dietary patterns were identified : ' whole food ' ( heavily loaded by vegetables , fruits and fish ) and ' processed food ' ( heavily loaded by sweetened desserts , fried food , processed meat , refined grains and high-fat dairy products ) . Self-reported depression was assessed 5 years later using the Center for Epidemiologic Studies - Depression ( CES-D ) scale . RESULTS After adjusting for potential confounders , participants in the highest tertile of the whole food pattern had lower odds of CES-D depression ( OR = 0.74 , 95 % CI 0.56 - 0.99 ) than those in the lowest tertile . In contrast , high consumption of processed food was associated with an increased odds of CES-D depression ( OR = 1.58 , 95 % CI 1.11 - 2.23 ) . CONCLUSIONS In middle-aged participants , a processed food dietary pattern is a risk factor for CES-D depression 5 years later , whereas a whole food pattern is protective BACKGROUND Adherence to a Mediterranean diet may improve longevity , but relevant data are limited . METHODS We conducted a population -based , prospect i ve investigation involving 22,043 adults in Greece who completed an extensive , vali date d , food-frequency question naire at base line .  Adherence to the traditional Mediterranean diet was assessed by a 10-point Mediterranean-diet scale that incorporated the salient characteristics of this diet ( range of scores , 0 to 9 , with higher scores indicating greater adherence ) . We used proportional-hazards regression to assess the relation between adherence to the Mediterranean diet and total mortality , as well as mortality due to coronary heart disease and mortality due to cancer , with adjustment for age , sex , body-mass index , physical-activity level , and other potential confounders . RESULTS During a median of 44 months of follow-up , there were 275 deaths . A higher degree of adherence to the Mediterranean diet was associated with a reduction in total mortality ( adjusted hazard ratio for death associated with a two-point increment in the Mediterranean-diet score , 0.75 [ 95 percent confidence interval , 0.64 to 0.87 ] ) . An inverse association with greater adherence to this diet was evident for both death due to coronary heart disease ( adjusted hazard ratio , 0.67 [ 95 percent confidence interval , 0.47 to 0.94 ] ) and death due to cancer ( adjusted hazard ratio , 0.76 [ 95 percent confidence interval , 0.59 to 0.98 ] ) . Associations between individual food groups contributing to the Mediterranean-diet score and total mortality were generally not significant . CONCLUSIONS Greater adherence to the traditional Mediterranean diet is associated with a significant reduction in total mortality Introduction Recent research suggests that diet quality influences  depression  risk ; however , a lack of experimental evidence leaves open the possibility that residual confounding explains the observed relationships . The aim of this study was to document the cross-sectional and longitudinal associations between  dietary patterns  and symptoms of depression and to undertake a detailed examination of potential explanatory factors , particularly socioeconomic circumstances , in the diet-depression relationship . Methods Data were drawn from the Personality and Total Health ( PATH ) Through Life Study , a longitudinal community study following three age cohorts ( 20 + ; 40 + ; 60+yrs ) from south-eastern Australia over three assessment periods ( n = 3663 ) .  Regression analyses evaluated the cross-sectional and longitudinal relationships between dietary patterns , depressive symptoms , age , detailed measures of socioeconomic circumstances , other health behaviours , and cardiovascular risk factors . Results The lowest tertile of prudent ( healthy ) dietary pattern and the highest tertile of western ( unhealthy ) dietary pattern were associated with an increased likelihood of depressive symptoms . However , these contemporaneous associations were explained by adjustment for detailed measures of socioeconomic circumstances and physical activity . In prospect i ve analyses , lower scores on the  healthy dietary pattern  and higher scores on the unhealthy  dietary pattern  independently predicted increased depressive symptoms across time , before and after adjustment for potential confounders and baseline depressive symptoms , but only for those in the oldest cohort . Dietary patterns did not explain the relationship between socioeconomic position and depressive symptoms . Conclusion The results of this study confirm that the relationship between habitual dietary intake and depressive symptoms is somewhat explained by socioeconomic circumstances and other health behaviours , but suggest that long term exposure to unhealthy dietary habits independently predisposes to depression over the lifecourse Emerging evidence relates some nutritional factors to depression risk . However , there is a scarcity of longitudinal assessment s on this relationship . Objective To evaluate the association between fatty acid intake or the use of culinary fats and depression incidence in a Mediterranean population . Material and Methods Prospect i ve cohort study ( 1999–2010 ) of 12,059 Spanish university graduates ( mean age : 37.5 years ) initially free of depression with permanently open enrolment . At baseline , a 136-item vali date d food frequency question naire was used to estimate the intake of fatty acids ( saturated fatty acids ( SFA ) , polyunsaturated fatty acids ( PUFA ) , trans unsaturated fatty acids ( TFA ) and monounsaturated fatty acids ( MUFA ) and culinary fats ( olive oil , seed oils , butter and margarine ) During follow-up participants were classified as incident cases of depression if they reported a new clinical diagnosis of depression by a physician and /or initiated the use of antidepressant drugs . Cox regression models were used to calculate Hazard Ratios ( HR ) of incident depression and their 95 % confidence intervals ( CI ) for successive quintiles of fats . Results During follow-up ( median : 6.1 years ) , 657 new cases of depression were identified . Multivariable-adjusted HR ( 95 % CI ) for depression incidence across successive quintiles of TFA intake were : 1 ( ref ) , 1.08 ( 0.82–1.43 ) , 1.17 ( 0.88–1.53 ) , 1.28 ( 0.97–1.68 ) , 1.42 ( 1.09–1.84 ) with a significant dose-response relationship ( p for trend = 0.003 ) . Results did not substantially change after adjusting for potential lifestyle or dietary confounders , including adherence to a Mediterranean Dietary Pattern . On the other h and , an inverse and significant dose-response relationship was obtained for MUFA ( p for trend = 0.05 ) and PUFA ( p for trend = 0.03 ) intake . Conclusions A detrimental relationship was found between TFA intake and depression risk , whereas weak inverse associations were found for MUFA , PUFA and olive oil . These findings suggest that cardiovascular disease and depression may share some common nutritional determinants related to subtypes of fat intake BACKGROUND Previous studies on diet and coronary heart disease ( CHD ) focused primarily on individual nutrients or foods . OBJECTIVE We examined whether overall dietary patterns derived from a food-frequency question naire ( FFQ ) predict  risk of CHD in men . DESIGN This was a prospect i ve cohort study of 44875 men aged 40 - 75 y without diagnosed cardiovascular disease or cancer at baseline in 1986 . RESULTS During 8 y of follow-up , we documented 1089 cases of CHD ( nonfatal myocardial infa rct ion and fatal CHD ) . Using factor analysis , we identified 2 major dietary patterns using dietary data collected through a 131-item FFQ . The first factor , which we labeled the " prudent pattern , " was characterized by higher intake of vegetables , fruit , legumes , whole grains , fish , and poultry , whereas the second factor , the " Western pattern , " was characterized by higher intake of red meat , processed meat , refined grains , sweets and dessert , French fries , and high-fat dairy products . After adjustment for age and CHD risk factors , the relative risks from the lowest to highest quintiles of the prudent pattern score were 1.0 , 0 . 87 , 0.79 , 0.75 , and 0.70 ( 95 % CI : 0.56 , 0.86 ; P : for trend = 0.0009 ) . In contrast , the relative risks across increasing quintiles of the Western pattern score were 1.0 , 1.21 , 1.36 , 1.40 , and 1.64 ( 95 % CI : 1.24 , 2.17 ; P : for trend < 0.0001 ) . These associations persisted in subgroup analyses according to cigarette smoking , body mass index , and parental history of myocardial infa rct ion . CONCLUSIONS These data suggest that major dietary patterns derived from the FFQ predict risk of CHD , independent of other lifestyle variables Background : It has been suggested that dietary patterns are associated with future risk of depressive symptoms . However , there is a paucity of prospect i ve data that have examined the temporality of this relation . Objective : We examined whether adherence to a healthy diet , as defined by using the Alternative Healthy Eating Index ( AHEI ) , was prospect ively associated with depressive symptoms assessed over a 5-y period . Design : Analyses were based on 4 
    Output:
    
Some previously described food patterns , specifically the Mediterranean Food Pattern , the Alternative Healthy Eating Index , the Prudent diet or the Provegetarian Food Pattern may be effective to reduce the future risk of depression .
Among them , only the Mediterranean Food Pattern has been tested for primary prevention in a large r and omised trial , but the inverse association found was not statistically significant .
Notwithst and ing , this field is promising and , according to large and well-conducted observational studies , food patterns potentially associated with reduced risk of depression are those emphasising seafood , vegetables , fruits and nuts .