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Substitutions of dairy product intake and risk of stroke: a Danish cohort study

Abstract

Low fat dairy products are part of dietary guidelines to prevent stroke. However, epidemiological evidence is inconclusive with regard to the association between dairy products and stroke. We therefore investigated associations for substitutions between dairy product subgroups and risk of total stroke and stroke subtypes. We included 55,211 Danish men and women aged 50–64 years without previous stroke. Baseline diet was assessed by a food frequency questionnaire. Cases were identified through a national register and subsequently verified. The associations were analyzed using Cox proportional hazard regression. During a median follow-up of 13.4 years, we identified 2272 strokes, of which 1870 were ischemic (318 large artery atherosclerotic, 839 lacunar, 102 cardioembolic, 98 other determined types, 513 of unknown type), 389 were hemorrhages (273 intracerebral, 116 subarachnoid) and 13 of unknown etiology. Substitution of semi-skimmed fermented milk or cheese for whole-fat fermented milk was associated with a higher rate of ischemic stroke [semi-skimmed fermented milk: hazard ratio (HR) = 1.20 (95% confidence interval (CI) 0.99–1.45), cheese: HR = 1.14 (95% CI 0.98–1.31) per serving/day substituted] and substitutions of whole-fat fermented milk for low-fat milk, whole-fat milk or buttermilk were associated with a lower rate [low-fat milk: HR = 0.85 (95% CI 0.74–0.99), whole-fat milk: HR = 0.84 (95% CI 0.71–0.98) and buttermilk: HR = 0.83 (95% CI 0.70–0.99)]. We observed no associations for substitutions between dairy products and hemorrhagic stroke. Our results suggest that intake of whole-fat fermented milk as a substitution for semi-skimmed fermented milk, cheese, buttermilk or milk, regardless of fat content, is associated with a lower rate of ischemic stroke.

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Acknowledgements

We wish to thank the Danish Cancer Society and the study personnel of the Diet, Cancer and Health cohort for data collection and management. We also wish to thank the study participants for their contribution to the study. This work was part of the project ‘Diet and prevention of ischemic heart disease: a translational approach’ (DIPI, www.dipi.dk), which is supported by the Danish Council for Strategic Research (Innovation Fund Denmark) (Contract 0603-00488B). The primary data collection for the Diet, Cancer and Health cohort was funded by the Danish Cancer Society. The funding agencies had no influence on the design, analysis or writing of this paper.

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Correspondence to Anne Sofie Dam Laursen.

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Laursen, A.S.D., Dahm, C.C., Johnsen, S.P. et al. Substitutions of dairy product intake and risk of stroke: a Danish cohort study. Eur J Epidemiol 33, 201–212 (2018). https://doi.org/10.1007/s10654-017-0271-x

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Keywords

  • Dairy products
  • Fermented milk
  • Cheese
  • Butter
  • Stroke
  • Substitution models
  • Cohort studies