***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: The aim of this study was to investigate the effects of vitamin D supplementation on serum aminotransferases , insulin resistance , oxidative stress , and inflammatory biomarkers in adult patients with non-alcoholic fatty liver disease ( NAFLD ) . Fifty-three patients with NAFLD were enrolled in a parallel , double-blind , placebo-controlled study . The patients were r and omly allocated to receive either one oral pearl consisting of 50,000 IU vitamin D3 ( n = 27 ) or a placebo ( n = 26 ) , every 14 days for 4 months . Serum aminotransferases , high-sensitive C-reactive protein ( hs-CRP ) , tumor necrosis factor α , malondialdehyde ( MDA ) , total antioxidant capacity , transforming growth factor β1 , as well as grade of hepatic steatosis and homeostasis model assessment of insulin resistance were assessed pre- and post-intervention . In patients who received vitamin D supplement compared to the controls , the median of serum 25(OH)D3 significantly increased ( 16.2 vs. 1.6 ng/ml , P < 0.001 ) . This increase accompanied by significant decrease in serum MDA ( −2.09 vs. −1.23 ng/ml , P = 0.03 ) and near significant changes in serum hs-CRP ( −0.25 vs. 0.22 mg/l , P = 0.06 ) . These between-group differences remained significant even after controlling for baseline covariates . Other variables showed no significant changes . Improved vitamin D status led to amelioration in serum hs-CRP and MDA in patients with NAFLD . This might be considered as an adjunctive therapy to attenuate systemic inflammation and lipid peroxidation alongside other treatments for NAFLD patients Abstract Mood changes synchronised to the seasons exist on a continuum between individuals , with anxiety and depression increasing during the winter months . An extreme form of seasonality is manifested as the clinical syndrome of seasonal affective disorder ( SAD ) with carbohydrate craving , hypersomnia , lethargy , and changes in circadian rhythms also evident . It has been suggested that seasonality and the symptoms of SAD may be due to changing levels of vitamin D3 , the hormone of sunlight , leading to changes in brain serotonin . Forty-four healthy subjects were given 400 IU , 800 IU , or no vitamin D3 for 5 days during late winter in a r and om double-blind study . Results on a self-report measure showed that vitamin D3 significantly enhanced positive affect and there was some evidence of a reduction in negative affect . Results are discussed in terms of their implication s for seasonality , SAD , serotonin , food preference , sleep , and circadian rhythms Pregnancy is a time of vulnerability for vitamin D insufficiency , and there is an emerging literature associating low levels of 25(OH)-vitamin D with depressive symptoms . However , the link between 25(OH)-vitamin D status in pregnancy and altered risk of postnatal depressive symptoms has not been examined . We hypothesise that low levels of 25(OH)-vitamin D in maternal serum during pregnancy will be associated with a higher incidence of postpartum depressive symptoms . We prospect ively collected sera at 18 weeks gestation from 796 pregnant women in Perth ( 1989–1992 ) who were enrolled in the Western Australian Pregnancy Cohort ( Raine ) Study and measured levels of 25(OH)-vitamin D.  Women reported postnatal depressive symptoms at 3 days post-delivery . Women in the lowest quartile for 25(OH)-vitamin D status were more likely to report a higher level of postnatal depression symptoms than women who were in the highest quartile for vitamin D , even after accounting for a range of confounding variables including season of birth , body mass index and sociodemographic factors . Low vitamin D during pregnancy is a risk factor for the development of postpartum depression symptoms OBJECTIVES  Postpartum depression ( PPD ) is a common disorder that affects 10 - 15 % of postpartum women , and it can have negative effects on both the mother and newborn . Recent studies have suggested that low levels of vitamin D are associated with poor mood and depression . The aim of this prospect i ve study was to evaluate a possible association between PPD and serum levels of 25-hydroxy vitamin D3 ( 25(OH)D3 ) , a reliable measurement of vitamin D , during mid-pregnancy . STUDY DESIGN The source population consisted of all pregnant women between 24 and 28 gestational weeks from June 2012 to October 2012 at Bornova Health Research and Application Hospital , Sifa University . In order to better evaluate a possible effect between vitamin D levels and PPD , individuals with characteristics that put them at risk for developing PPD were excluded from the study . Serum 25(OH)D3 levels were evaluated mid-pregnancy in the study group . Serum 25(OH)D3 concentrations ≤20ng/mL ( 50nmol/L ) were classified as a mild deficiency and those ≤10ng/mL ( 25nmol/L ) were classified as a severe deficiency . Pregnant subjects having complications during birth or with the newborn after delivery were excluded from the study . The Edinburgh Postnatal Depression Scale ( EPDS ) was used to assess maternal PPD 1 week , 6 weeks , and 6 months after delivery . A Pearson correlation was used to measure the strength of the associations between the EPDS scores and vitamin D levels analyzed during the three time periods . A logistic regression analysis was used to determine the independent effects of vitamin D on PPD . RESULTS Six hundred and eighty-seven pregnant women were included in this study . After excluding women due to PPD risk factors ( in two stages ) , 179 pregnant women were screened for vitamin D levels during mid-pregnancy and in the 6th month postpartum . Eleven percent of our study group had severe vitamin D deficiency and 40.3 % had mild vitamin D deficiency . The frequency of PPD was 21.6 % at the 1st week , 23.2 % at 6th week , and 23.7 % at the 6th month . There was a significant relationship between low 25(OH)D3 levels in mid-pregnancy and high EPDS scores , which is indicative of PPD for all three follow-up periods ( p=0.003 , p=0.004 and p<0.001 , respectively ) . In addition , there was a significant negative correlation between vitamin D levels and EDPS at all three time points ( r=-0.2 , -0.2 , -0.3 , respectively ) . CONCLUSIONS Vitamin D deficiency in mid-pregnancy may be a factor affecting the development of PPD . More extensive studies are required to be carried out on this subject Vitamin D deficiency and elevated pro-inflammatory cytokines have each been associated individually with postpartum depression ( PPD ) . African American women are at increased risk for prenatal vitamin D deficiency , inflammation , and prenatal and postpartum depressive symptoms , but biological risk factors for PPD in this population have rarely been tested . This prospect i ve study tested whether low prenatal vitamin D status ( serum 25-hydroxyvitamin D , 25[OH]D ) predicted PPD symptomatology in pregnant African American women and whether high levels of prenatal inflammatory cytokines interacted with low 25(OH)D in effects on PPD symptoms .  Vitamin D status was measured in the first trimester in a sample of 91 African American pregnant women who had a second trimester blood sample assayed for inflammatory markers . Depressive symptoms were assessed at a postpartum visit . An inverse association between prenatal log 25(OH)D and PPD symptomatology approached significance ( β = −0.209 , p = 0.058 ) , and interleukin-6 and IL-6/IL-10 ratio significantly moderated the effect . Among women with higher levels of inflammatory markers  , lower prenatal log 25(OH)D was associated with significantly higher PPD symptoms ( p < 0.05 ) . These preliminary results are intriguing because , if replicable , easy translational opportunities , such as increasing vitamin D status in pregnant women with elevated pro-inflammatory cytokines , may reduce PPD symptoms BACKGROUND  Postpartum depression ( PPD ) is a widespread worldwide phenomenon , but its etiology remains unclear . This study reappraised how evolutionary theory could explain PPD as an adaptation through investigating the relationship between maternal age and PPD , and if this relationship is modified according to the number of children at home . METHODS A cross-sectional study carried out in five primary health care units included 811 participants r and omly selected among mothers of children up to five postpartum months in Rio de Janeiro , Brazil .  Postpartum depression was defined by scores above 11 on Edinburgh Postnatal Depression Scale ( EPDS ) , and statistical analysis was based on multivariate logistic regression models . RESULTS One hundred and ninety-seven ( 24.3 % , CI 95 % 21.3 - 27.2 ) participants were classified as PPD positives . Maternal age was significantly associated to PPD ( OR=0.96 , p-value=0.019 ) independently of socioeconomic and reproductive characteristics , conjugal status or substance consumption by the couple . Thus , for each additional year , a reduction of 4 % in the chance of developing PPD could be anticipated , effect which was not modified by the number of children at home ( p-value=0.602 ) . LIMITATIONS Information on social support was not included in this analysis since its relationship with maternal mental health would be better evaluated in a prospect i ve fashion . CONCLUSIONS These findings suggest that adaptive mechanisms shaped through human generations persist contributing to the development of PPD in contemporary societies . According to this evolutionary approach , as maternal age advances the reproductive potential diminishes and , consequently , mothers are less prone to develop PPD and reduce investment in new offspring 
    Output:
    
Findings from cohort studies suggest that vitamin-D deficiency is related to the incidence of PPD and vitamin D may play a significant role in the recovery of women with PPD , but it is uncertain whether these actions are the effect of vitamin D on the function of hypothalamic-pituitary-adrenal ( HPA ) axis , the levels of estradiol , serotonin , pro-inflammatory cytokines , and /or of other mechanisms involved in PPD