Abstract
Objectives
To investigate associations between time updated information of milk and fermented milk consumption and risk of total stroke.
Methods
We included 79,613 Swedish adults (35,892 women and 43,721 men), 45–83 years of age, without stroke at baseline in 1997 (SIMPLER, simpler4health.se). The participants completed a validated 96-item food frequency questionnaire including questions about milk and soured milk and yogurt consumption at baseline and in 2009. Incident and previous stroke cases were identified by linkage with the Swedish National Patient and Cause of Death Registers. Associations between milk and fermented milk intake and incident total stroke were assessed by restricted cubic spline Cox regression. We included the baseline covariates sex and educational level, and time updated exposures and covariates (age, smoking, total energy intake, body mass index, physical activity, living alone, coffee, vitamin- and mineral supplements, alcohol consumption, hypertension, hypercholesterolemia, diabetes mellitus, coronary heart disease, weighted Charlson Comorbidity Index, and intakes of fermented milk (in analyses of milk), milk (in analyses of fermented milk), fruits and vegetables, processed meat, soft drink, juice, total fat, and saturated fat) from 2009.
Results
The average intake in 1997 was 260 grams (g)/day (d) for milk and 160 g/d for fermented milk (200 g corresponds to 1 glass). During a mean follow-up of 17.7 years (maximum follow-up of 22 years), 9736 total stroke cases were identified. P-values for non-linearity were 0.010 for milk and 0.721 for fermented milk. Compared with zero intake the Hazard ratio (HR) for milk intake was 0.95 (95% Confidence Interval (CI) 0.91, 0.99) for 200 g/d, 0.94 (95% CI 0.89, 1.00) for 400 g/d, and 0.97 (95% CI (0.91, 1.02) for 600 g/d. For fermented milk intake the HR was 0.99 (95% CI 0.95, 1.04) for 200 g/day, 1.00 (0.95% CI 0.95, 1.05) for 400 g/d, and 1.01 (95% CI 0.95, 1.07) for 600 g/d compared with zero intake.
Conclusions
A low to moderate, but not higher, milk consumption (1–2 glasses/d) seem to have a protective effect on total stroke, compared to zero intake. Consumption of fermented milk was not associated with total stroke.
Funding Sources
SIMPLER is funded by Vetenskapsrådet. The current work is funded by Forte.