***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 Although lifestyle interventions targeting multiple lifestyle behaviors are more effective in preventing unhealthy weight gain and chronic diseases than intervening on a single behavior , few studies have compared individual and combined effects of diet and /or exercise interventions on health-related quality of life ( HRQOL ) . In addition , the mechanisms of how these lifestyle interventions affect HRQOL are unknown . The primary aim of this study was to examine the individual and combined effects of dietary weight loss and /or exercise interventions on HRQOL and psychosocial factors ( depression , anxiety , stress , social support ) . The secondary aim was to investigate predictors of changes in HRQOL . Methods This study was a r and omized controlled trial . Overweight/obese postmenopausal women were r and omly assigned to 12 months of dietary weight loss ( n = 118 ) , moderate-to-vigorous aerobic exercise ( 225 minutes/week , n = 117 ) , combined diet and exercise ( n = 117 ) , or control ( n = 87 ) . Demographic , health and anthropometric information , aerobic fitness , HRQOL ( SF-36 ) , stress ( Perceived Stress Scale ) , depression [ Brief Symptom Inventory (BSI)-18 ] , anxiety ( BSI-18 ) and social support ( Medical Outcome Study Social Support Survey ) were assessed at baseline and 12 months . The 12-month changes in HRQOL and psychosocial factors were compared using analysis of covariance , adjusting for baseline scores . Multiple regression was used to assess predictors of changes in HRQOL . Results Twelve-month changes in HRQOL and psychosocial factors differed by intervention group . The combined diet + exercise group improved 4 aspects of HRQOL ( physical functioning , role-physical , vitality , and mental health ) , and stress ( p ≤ 0.01 vs. controls ) . The diet group increased vitality score ( p < 0.01 vs. control ) , while HRQOL did not change differently in the exercise group compared with controls . However , regardless of intervention group , weight loss predicted increased physical functioning , role-physical , vitality , and mental health , while increased aerobic fitness predicted improved physical functioning . Positive changes in depression , stress , and social support were independently associated with increased HRQOL , after adjusting for changes in weight and aerobic fitness . Conclusions A combined diet and exercise intervention has positive effects on HRQOL and psychological health , which may be greater than that from exercise or diet alone . Improvements in weight , aerobic fitness and psychosocial factors may mediate intervention effects on HRQOL.Trial Registration Clinical Trials , Clinical Trials.gov register , Background : The impact of dietary flavonoid intakes on risk of depression is unclear . Objective : We prospect ively examined associations between estimated habitual intakes of dietary flavonoids and depression risk . Design : We followed 82,643 women without a previous history of depression at baseline from the Nurses ’ Health Study [ ( NHS ) aged 53–80 y ] and the Nurses ’ Health Study II [ ( NHSII ) aged 36–55 y ] .  Intakes of total flavonoids and subclasses ( flavonols , flavones , flavanones , anthocyanins , flavan-3-ols , polymeric flavonoids , and proanthocyanidins ) were calculated from vali date d food-frequency question naires collected every 2–4 y. Depression was defined as physician- or clinician-diagnosed depression or antidepressant use and was self-reported in response to periodic question naires . Cox proportional hazards models were performed to examine associations . Results : A total of 10,752 incident depression cases  occurred during a 10-y follow-up . Inverse associations between flavonol , flavone , and flavanone intakes and depression risk were observed . Pooled multivariable-adjusted HRs ( 95 % CIs ) were 0.93 ( 0.88 , 0.99 ) , 0.92 ( 0.86 , 0.98 ) , and 0.90 ( 0.85 , 0.96 ) when comparing the highest ( quintile 5 ) with the lowest ( quintile 1 ) quintiles , respectively , with evidence of linear trends across quintiles ( P-trend = 0.0004–0.08 ) . In flavonoid-rich food-based analyses , the HR was 0.82 ( 95 % CI : 0.74 , 0.91 ) among participants who consumed ≥2 servings citrus fruit or juices/d compared with < 1 serving/wk . In the NHS only , total flavonoids , polymers , and proanthocyanidin intakes showed significantly ( 9–12 % ) lower depression risks . In analyses among late-life NHS participants ( aged ≥65 y at baseline or during follow-up ) , for whom we were able to incorporate depressive symptoms into the outcome definition , higher intakes of all flavonoid subclasses except for flavan-3-ols were associated with significantly lower depression risk ; flavones and proanthocyanidins showed the strongest associations ( HR for both : 0.83 ; 95 % CI : 0.77 , 0.90 ) . Conclusions : Higher flavonoid intakes may be associated with  lower depression risk  , particularly among older women . Further studies are needed to confirm these associations Objectives : We investigated whether a Mediterranean-style diet ( MedDiet ) supplemented with fish oil can improve mental health in adults suffering depression . Methods : Adults with self-reported depression were r and omized to receive fortnightly food hampers and MedDiet cooking workshops for 3 months and fish oil supplements for 6 months , or attend social groups fortnightly for 3 months . Assessment s at baseline , 3 and 6 months included mental health , quality of life ( QoL ) and dietary question naires , and blood sample s for erythrocyte fatty acid analysis . Results : n = 152 eligible adults aged 18–65 were recruited ( n = 95 completed 3-month and n = 85 completed 6-month assessment s ) . At 3 months , the MedDiet group had a higher MedDiet score ( t = 3.95 , P < 0.01 ) , consumed more vegetables ( t = 3.95 , P < 0.01 ) , fruit ( t = 2.10 , P = 0.04 ) , nuts ( t = 2.29 , P = 0.02 ) , legumes ( t = 2.41 , P = 0.02 ) wholegrains ( t = 2.63 , P = 0.01 ) , and vegetable diversity ( t = 3.27 , P < 0.01 ) ; less unhealthy snacks ( t = −2.10 , P = 0.04 ) and red meat/chicken ( t = −2.13 , P = 0.04 ) . The MedDiet group had greater reduction in depression ( t = −2.24 , P = 0.03 ) and improved mental health QoL scores ( t = 2.10 , P = 0.04 ) at 3 months . Improved diet and mental health were sustained at 6 months . Reduced depression was correlated with an increased MedDiet score ( r = −0.298 , P = 0.01 ) , nuts ( r = −0.264 , P = 0.01 ) , and vegetable diversity ( r = −0.303 , P = 0.01 ) . Other mental health improvements had similar correlations , most notably for increased vegetable diversity and legumes . There were some correlations between increased omega-3 , decreased omega-6 and improved mental health . Discussion : This is one of the first r and omized controlled trials to show that healthy dietary changes are achievable and , supplemented with fish oil , can improve mental health in people with depression Older individuals with emotional distress and a history of psychologic trauma are at risk for post traumatic stress disorder ( PTSD ) and major depression . This study was an exploratory , secondary analysis of data from the study " Prevention of Depression in Older African Americans " . It examined whether Problem Solving Therapy- Primary Care ( PST-PC ) would lead to improvement in PTSD symptoms in patients with subsyndromal depression and a history of psychologic trauma . The control condition was dietary education ( DIET ) .  Participants ( n=60 ) were age 50 or older with scores on the Center for Epidemiologic Studies -Depression scale of 11 or greater and history of psychologic trauma . Exclusions stipulated no major depression and substance dependence within a year . Participants were r and omized to 6 - 8 sessions of either PST-PC or DIET and followed 2 years with booster sessions every 6 months ; 29 participants were in the PST-PC group and 31 were in the DIET group . Mixed effects models showed that improvement of PTSD Check List scores was significantly greater in the DIET group over two years than in the PST-PC group ( based on a group time interaction ) . We observed no intervention⁎time interactions in Beck Depression Inventory or Brief Symptom Inventory-Anxiety subscale scores PURPOSE To conduct a clinical trial to determine if an educational intervention and a nutritional intervention could enhance physical and psychological functioning among younger women completing treatment for early-stage breast cancer . PATIENTS AND METHODS Younger women ( 50 years of age or younger , N = 252 ) , within 2 months of having completed active nonhormonal adjuvant therapy , diagnosed with stage 0 , I , or II breast cancer with 10 or fewer positive lymph nodes were r and omly assigned to a three-arm clinical trial . Women in the control arm of the trial received st and ard medical care . Women in the two active arms received either an educational intervention , design ed to provide information about their illness and enhance adjustment , or a nutritional intervention , design ed to promote a more healthy diet . Primary end points included mental functioning , physical functioning , and depressive symptoms . Women were assessed before r and om assignment , 4 months later ( immediately post-intervention ) , and 13 months later ( 9 months post-intervention ) . RESULTS Participants assigned to the two active treatment arms had significantly less depressive symptomatology and better physical functioning by 13-month follow-up ( differences between the two active arms were nonsignificant ) . These effects were primarily accounted for by changes in intrusive thoughts , concerns regarding cancer recurrence and mortality , self-concept perceptions , and self-efficacy expectations . CONCLUSION Tailored psychosocial interventions can be effectively design ed to enhance adjustment among younger women who are completing nonhormonal adjuvant therapy BACKGROUND Intensive dietary intervention programs may lead to benefits in vitality and other components of health quality . The Women 's Health Initiative Dietary Modification ( DM ) intervention includes a large r and omized controlled trial of an intensive intervention . OBJECTIVE To evaluate whether the intervention is associated with improved health-related quality of life ( HRQoL ) subscales , overall self-reported health , depression symptoms , cognitive functioning , and sleep quality . DESIGN This r and omized controlled trial was analyzed as intent to treat . PARTICIPANTS Between 1993 and 1998 , 48,835 women aged 50 to 79 years were recruited by 40 clinical centers across the United States . Eligibility included having fat intake at baseline ≥32 % of total calories , and excluded women with any prior colorectal or breast cancer , recent other cancers , type 1 diabetes , or medical conditions with predicted survival <3 years . INTERVENTION Goals were to reduce calories from fat to 20 % , increase vegetables and fruit to 5 + servings , and increase grain servings to 6 + servings a day . During the first year , 18 group sessions were held , with quarterly sessions thereafter . MAIN OUTCOME MEASURES The R AND 36-Item Health Survey was used to assess HRQoL at baseline , Year 1 , and close-out ( about 8 years postr and omization ) , and estimate differential HRQoL subscale change scores . STATISTICAL ANALYSES PERFORMED Mean change in HRQoL scores ( Year 1 minus baseline ) were compared by r and omization group using linear models . RESULTS At 1 year , there was a differential change between intervention and comparison group of 1.7 units ( 95 % CI 1.5 , 2.0 ) in general health associated with the intervention . DM intervention improved physical functioning by 2.0 units ( 95 % CI 1.7 , 2.3 ) , vitality by 1.9 units ( 95 % CI 1.6 , 2.2 ) , and global quality of life by 0.09 units ( 95 % CI 0.07 , 0.12 ) . With the exception of global quality of life , these effects were significantly modified by body mass index at baseline . CONCLUSIONS DM intervention was associated with small , but significant improvements in three HRQoL subscales : general health , physical functioning , and vitality at 1 year follow-up , with the largest improvements seen in the women with the greatest baseline body mass index Background The possible therapeutic impact of dietary changes on existing mental illness is largely unknown . Using a r and omised controlled trial design , we aim ed to investigate the efficacy of a dietary improvement program for the treatment of  major depressive episodes .  Methods ‘ SMILES ’ was a 12-week , parallel-group , single blind , r and omised controlled trial of an adjunctive dietary intervention in the treatment of moderate to severe depression . The intervention consisted of seven individual nutritional consulting sessions delivered by a clinical dietician 
    Output:
    
Studies with female sample s observed significantly greater benefits from dietary interventions , for symptoms of both depression and anxiety .
Conclusions Dietary interventions hold promise as a novel intervention for reducing symptoms of depression across the population .