Social support mediates intersectional inequalities in fruit and vegetable intake in Germany

Fruit and vegetable intake (FVI) protects against non-communicable disease, yet remains below recommendations with persistent social inequalities by gender, education, and age. Intersectional inequalities in FVI have rarely been examined, and their determinants remain poorly understood. We applied an intersectional moderated mediation framework to examine social support (through perceived social support (PSS)) as a mediator of intersectional inequalities in FVI, assessing both PSS’s mediation role and the extent to which this mediation varies in strength across intersectional groups. Using cross-sectional data from the 2019 European Health Interview Survey in Germany (N=22,433), we constructed eight intersectional groups by combining gender (men, women), age (<55, ≥55), and education (with/without university education). PSS was assessed with a six-point scale. We estimated a second-stage moderated mediation model using multiple linear regressions to obtain direct and indirect effects and the index of moderated mediation, with 95% confidence intervals calculated using nonparametric percentile-based bootstrapping (5,000 resamples). We found that older men without a university education reported the lowest FVI. Furthermore, PSS significantly mediated FVI inequalities across all intersectional groups. Importantly, mediation strength varied significantly: the strongest indirect effects were observed among women, particularly those with university education, and the weakest among young men without university education, suggesting that PSS’s role in shaping FVI is itself socially patterned. Taken together, these results show that intersectional FVI inequalities are partly explained by group differences in PSS levels and the extent to which PSS translates into FVI, with young men without university education benefiting the least. Tailoring support structures to group-specific pathways could help reduce these inequalities.