J-milk's argument for the cohort studies about adverse healtheffects of milk in Sweden
1. Summary of this study
On 29 October, the study targeted at Swedes (the analysis of two large scale cohort
studies which tracked both men and women for maximum of 20 years with the focus on
their dietary habits and the examination of the connection between the amount of milk
consumption and the risk of fracture and mortality) was published in the British Medical
Journal.
Summary of the published study result is as follows.
In women, a higher risk of death was observed in the follow up period among ones whodrank more than 200g of milk a day than the ones who drank less than 200g a day. Theincrease in risk was 21% for women with consumption of 1-2 glasses of milk a day and
93% for 3 glasses or more a day. Furthermore, the increase of the bone fracture risk
was associated with drinking more than a glass of milk a day in women.
In men, no such clear association was observed for either bone fracture or death.
The study also pointed out that a higher intake of fermented milk products such ascheese and yoghurt was associated with reduced risk of mortality and fracture
particularly in women, and they suggested as the logical explanation that drinking milk
contains high level of "D-Galactose" (a type of sugar) unlike fermented milk products.

2. Reaction of public opinion to this study
The result of this study was broadcasted on major network news in Japan and perceived
with the impact.
For many years, vast amount of studies were carried out on nutritional health functionsof milk globally, and various evidences have been published. Since the result of thisstudy has contents which overturn the traditional findings, the questions about thevalidity of this study and its method of drawing its conclusion were raised both in Japanand abroad, and there are discussions over the evaluation of this study among theresearchers.

3. J Milk's comments
Under these circumstances, J Milk has collected the comments on this study from thespecialist researchers (Milk and Dairy Products Health Science Commission, researcher
members of the Milk Academic Alliance) and summarised our evaluation of this study byreferring also to the comments of the researchers from various countries gathered by theInternational Dairy Federation.

However, this is still an interim report since the institutions such as the International
Dairy Federation continue with their professional evaluation of this study, and theirofficial views are to be announced at an early date.

(1). Observational studies like this one (a study performed by collecting data about
health and illness without any intervention) get influenced by innumerable constraint
conditions and have characteristics of their inability to identify correct causal relationship,
therefore, such conclusion must be treated with caution.
(2). In addition, the subjects of this study were mainly the Swedes with some people ofneighbouring countries, and this study may not apply to other regions with different
lifestyles and living conditions.
For example, the milk intake in these countries is higher than the Japanese average,
and there is considerable difference in calcium intake. The average calcium intake of
the women who were the subjects of the survey in this study was more than 700mg perday, and the relevant average of the Japanese women aged 20 years and over is 431mg
per day (2012 National Health and Nutrition Survey by the Ministry of Health, Labour andWelfare).
Furthermore, vitamin A is added to drinking milk in Sweden. (a vitamin A intake is known
to be related to a bone fracture risk)(3). In relation to milk, it is important to remember the fact that the scientific evidence so
far accumulated and many previous articles indicate the opposite result to this study.
(Major studies provided as reference)1). Milk Drinking and Mortality: Findings from the Japan Collaborative Cohort Study(Japanese cohort study, J. Epidemiol. 2014)2). Milk and dairy consumption and incidence of cardiovascular diseases and all-cause
mortality: does-response meta-analysis of prospective cohort studies(WageningenUniversity, Am J Clin Nutr. 2011)
3). Dairy and bone health (J Am Coll Nutr. 2009)4). Milk intake and risk of his fracture in men and women: a meta-analysis ofprospective cohort studies (J Bone Miner Res. 2011)
Particularly, in the similar cohort study published on 18 October this year in Japan, thelower mortality was observed in the cases of the minimum milk intake of 1-2 times permonth in men and 2-3 times a week in women compared to non-milk intake, and thisresult has attracted attention.
(4). This study formed a hypothesis that "D-galactose is not good for human health" as arationale from the results which indicated increase of the bone fracture risk and themortality with drinking milk and decrease with fermented milk products. This hypothesis
is based on the established experimental model for premature ageing including
shortened life span caused by oxidative stress and chronic inflammation when Dgalactose is given to laboratory animals (mice, rats and drosophila flies), and it is still
unclear whether this result could be generalised to human.
Also, the amount of lactose/galactose in milk and fermented milk products are not so
different, and fermented milk products contain more vitamin K than milk (vitamin K is
known to be linked to the health of bone and cardiovascular system), these facts need tobe considered.

From the above, a conclusion should not be drawn solely on the grounds of the article ofthis study, and eating habits (especially the way of consuming milk) should not beaffected by it.
Also, when broadcasting such study, it is particularly important the other researchers’
evaluations of its study method and results to be considered and the other studies of asimilar theme to be compared with.