title: Ethnic differences in maternal dietary patterns are largely explained by socio-economic score and integration score: a population-based study.
abstract: BACKGROUND
  The impact of socio-economic position and integration level on the observed ethnic differences in dietary habits has received little attention.
  
  
  OBJECTIVE
  To identify and describe dietary patterns in a multi-ethnic population of pregnant women, to explore ethnic differences in odds ratio (OR) for belonging to a dietary pattern, when adjusted for socio-economic status and integration level and to examine whether the dietary patterns were reflected in levels of biomarkers related to obesity and hyperglycaemia.
  
  
  METHODS
  This cross-sectional study was a part of the STORK Groruddalen study. In total, 757 pregnant women, of whom 59% were of a non-Western origin, completed a food frequency questionnaire in gestational week 28±2. Dietary patterns were extracted through cluster analysis using Ward's method.
  
  
  RESULTS
  Four robust clusters were identified where cluster 4 was considered the healthier dietary pattern and cluster 1 the least healthy. All non-European women as compared to Europeans had higher OR for belonging to the unhealthier dietary patterns 1-3 vs. cluster 4. Women from the Middle East and Africa had the highest OR, 21.5 (95% CI 10.6-43.7), of falling into cluster 1 vs. 4 as compared to Europeans. The ORs decreased substantially after adjusting for socio-economic score and integration score. A non-European ethnic origin, low socio-economic and integration scores, conduced higher OR for belonging to clusters 1, 2, and 3 as compared to cluster 4. Significant differences in fasting and 2-h glucose, fasting insulin, glycosylated haemoglobin (HbA1c), insulin resistance (HOMA-IR), and total cholesterol were observed across the dietary patterns. After adjusting for ethnicity, differences in fasting insulin (p=0.015) and HOMA-IR (p=0.040) across clusters remained significant, despite low power.
  
  
  CONCLUSIONS
  The results indicate that socio-economic and integration level may explain a large proportion of the ethnic differences in dietary patterns.
authors.affiliation: Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway ; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Christine
authors.initials: C
authors.lastname: Sommer
authors.forename: Line
authors.initials: L
authors.lastname: Sletner
authors.forename: Anne K
authors.initials: AK
authors.lastname: Jenum
authors.forename: Kjersti
authors.initials: K
authors.lastname: Mørkrid
authors.forename: Lene F
authors.initials: LF
authors.lastname: Andersen
authors.forename: Kåre I
authors.initials: KI
authors.lastname: Birkeland
authors.forename: Annhild
authors.initials: A
authors.lastname: Mosdøl
keywords: dietary patterns; ethnic minority groups; immigrants; integration level; socio-economic status