A study of factors affecting fruit and vegetable consumption and a retail assessment in selected districts in Malta

Abstract

Background: Fruit and vegetable (FV) consumption is a foundation of a healthy diet, with the World Health Organization and Food and Agriculture Organisation of the United Nations jointly recommending at least 400 g (roughly five portions) per day to reduce non-communicable disease risk. In Malta, over one in four adults live with obesity and only ~12 % meet the five-a-day intake. This study aimed to assess FV intakes and drivers, particularly barriers, among adults aged 18-65 years in Malta and explore the local FV retail environment across two selected districts. Methods: The study included two phases. The first phase consisted of a 33-question, cross-sectional, anonymised survey, which was adapted, translated and piloted for Malta, then distributed online via Google Forms using convenience sampling Questions covered FV consumption, local retail environment perceptions and socio-demographic characteristics. The second phase focused on the assessment of FV retail outlets selected in two selected districts, the Northern Harbour and South Eastern districts. This assessment included measuring the number of retail outlets in 4 different localities, mapping their locations using Geographic Information Systems (GIS), and collecting data on the quality and cost of selected FV in eleven conveniently selected outlets within 4 different localities. Results: Data from 315 respondents (mean age 44.5 years; 72.4 % female; mean BMI 26.4 kg/m2) were analysed using Chi-square or Fisher-Freeman-Halton exact tests, Spearman’s correlations and cross-tabulations. Mean daily intake was 1.7 fruit and 1.8 vegetable portions. Around 51.0% of participants were classified in the overweight and obese ranges. Fruit intake increased with age (p < .05) and decreased with higher BMI (p < .05). Cost barriers were significant among lower-income households (p = .001), non-EU nationals (44.4 %, p < .001) and younger adults (p < .001). Larger households consumed more vegetables (p=0.003), but no significant associations were found between consumption frequency and gender, education or taste preferences (p >.05). Regarding shopping habits, 64.7 % of respondents travelled to purchase FV by car, while 44.8 % went on foot. Main desired improvements to better FV intake included lower prices (57.5 %), better quality (37.5 %) and more variety (28.4 %). Comparing the two selected districts, tests showed no difference in FV intake (p>.20). Quality and price assessments revealed that visual defects, °Brix and pH influenced retail prices across multiple crops (p<0.05). Spatial analyses confirmed that there was good availability of FV outlets in two most populated towns of selected districts and most participants lived within a 5-minute walk of an FV outlet. Discussion: FV intake in Malta remains relatively low, particularly among younger, lower-income and non-EU groups, similar consumption across districts. Affordability emerged as the primary barrier. Targeted interventions, such as subsidies for vulnerable pockets and community-tailored educational campaigns, are needed to boost FV consumption and reduce chronic disease risk.