ABSTRACTSocio-cultural perceptions and practices of dietary choices with focus on fat intake in middle aged Pakistani women in Oslo – a qualitative studyIntroduction: The nutritional transition has resulted globally in dietary changes, of which high intake of fats, sugar and refined carbohydrates are some of the main characteristics. This has resulted in increase in lifestyle diseases like type 2 Diabetes and Coronary Heart Disease. In Norway, a dramatic increase of type 2 Diabetes has been observed in migrant populations especially from the Indian subcontinent. Amongst these groups, prevention has resulted to some extent in increasing knowledge about the adversary effects of sugar and reduced intake of visible sugar. However this does not seem to be the case with fats leaving the issue of fats unattended. I wished therefore to explore perceptions and practices related to dietary fat intake in middle aged Pakistani women in Oslo. In particular, the intake of ghee(clarified butter) was interesting to explore, as ghee is a highly saturated fat and is an important component of the Asian dietary tradition. My objectives were therefore the following:• To study socio-cultural perceptions and practice of dietary choices with focus on fat intake in middle aged Pakistani women in Oslo• To identify possible barriers to changes in healthy choices of dietary fat intake • To discuss its implications in preventive health care.Methodology: A qualitative method was chosen using in-depth interviews conducted with the help of an interview guide. This was supplemented by a structured questionnaire. Interviews were conducted on 12 Pakistani women in the age group 42-70 years in the period October-December 2002. The women were recruited at a centre for the elderly called Grûnerløkka Eldresenter and their informed written consent obtained. Interviews were conducted in Hindi/Urdu at the women’s convenience either in their homes or at the centre. Tape recordings were later transcribed and analysed by the principal investigator.Results and discussion: The study explored post migratory cooking methods, cooking medium and food selection. In the case of cooking methods, foods were mostly prepared as traditional curries or fried. This was done to provide”digestibility”and was similar to methods used before migration. Roasting, grilling and baking were also employed to some extent. Plain, boiled food was seldom eaten being reserved for people with “weak digestion” like babies, sick and old people. Concerning cooking medium, especially after family reunion, the womens main cooking medium was home made ghee symbolising “nourishment” and providing “correct taste”. In addition to ghee, low cost, refined plant oils like sunflower, corn oil were used for deep frying of ethnic snacks. Later, due to failing health and dietary recommendations, plant oils became the main cooking medium. Ghee was now reserved for providing nourishment of children’s foods and for taste in traditional festive foods. Plant oils were bought in large quantities and used generously with no attention paid to nutritional content, dates or quantity. Plant oils that were used for deep frying were reused several times over a period of several weeks. Some had tried olive oil but discontinued its usage due to unfamiliar taste and unsuitability and high price. In general, plant oils did not have the same status as ghee providing less nourishment in the women’s thinking. Concerning food selection, an increased intake of foods of animal origin was reported which was perceived as nourishing. Intake of red meats was high, as it was eaten daily in most households. All meat was ritually slaughtered classified as halal. Intake of vegetable and lentils remained negligible. Later due to failing health, and dietary recommendations, intake of white meats(chicken/fish)were added to red meat intake. This also matched adult childrens perceptions of healthy foods which they had integrated from the host population. However, cooking methods remained unaltered and risky as unskinned chicken and fish were made primarily as curries. When roasted or grilled, chicken was eaten as a side dish to a red meat curry. The same applied to baked fish. The most common fish intake remained fried fish fingers or fish burgers. The intake of vegetables and lentils was negligible. The few times vegetables and lentils were included, they were added to a meat curry, or made as a pure vegetable or pure lentil curry often with a meat curry in addition. Vegetables were also popularly fried. In the public sphere, foods served to guests were lavish, energy dense festive foods, primarily of animal origin, along with deep fried festive snacks and sweet desserts. As a guest one expected to be served such foods.Conclusion with implications for public health: The study shows that after migrating, despite following dietary recommendations of reducing sugar, ghee, switching to plant oils, and consuming more white meats and foods of vegetable origin, the impression was that total fat intake remained high due to cooking methods, choice of cooking medium and selection of foods as reported by the women.This was a general impression as no data on measuring of fat intake was done. Concerning fats, the study shows that the message “fat is harmful” as conveyed by the health professional is insufficient without the understanding of the role of such foods in the lives of these particular women. Future dietary messages must take cultural and ethnic differences into consideration and be tailored for each specific ethnic group. In addition, women’s health must be given importance, empowering them to make good decisions concerning their health. This will remain a public health challenge.