**1. Introduction**

The world population is ageing and by 2050 there will be more older than younger people [1]. Even though population ageing is a human achievement, there are still many health policy challenges to be addressed [2]. Increases in life expectancy have not been followed by relevant increases in disease-free years, meaning that people are living longer but are spending more years with illness and disability [3]. Living longer but in ill health could result in severe demand of public and health care resources [4]. As people experience ageing with grea<sup>t</sup> heterogeneity in their health pathways [5], it is crucial to identify those behaviours that are associated with a slower and healthier ageing process.

Until recently, healthy ageing research has been complicated by a lack of common definition and measurement of it [6,7]. However, the latest report on health and ageing from the World Health Organization (WHO) provided a common framework to conceptualise healthy ageing; the functional ability framework. Healthy ageing is now defined as the process of developing and maintaining the functional ability that enables well-being in older age [8]. Healthy lifestyle behaviours (for instance, never smoking, moderate alcohol consumption, physical activity and daily consumption of fruits and vegetables) have been consistently associated with better health outcomes in older people: successful ageing [9], increases in life-years spent in good health [10], a reduced risk of mortality [11,12], and of poor cognitive function [13]. Recent systematic reviews also indicated the beneficial effects of physical activity, non-smoking and of a healthy diet to healthy ageing [2,14,15].

The latter reviews also revealed the lack of evidence in low-and-middle income countries (LMICs) even though it is estimated that by 2050, 80% of the global population that is 60 years old and over will reside there [16]. Among those countries, Latin American and the Caribbean (LAC) are the ones that have been witnessing an increased life expectancy from 1990 to 2016 [17] and projections show that in the next 15 years they are to experience the fastest increase in the number of older people [1]. Dietary risk, physical inactivity, alcohol use and smoking are among the top leading factors of disability-adjusted life years (DALYs) in the area [18].

In this study, we aimed to examine the impact of four healthy lifestyle behaviours (i.e., physical activity, non-smoking, moderate alcohol consumption and consumption of fruits and vegetables), individually and in combination, on healthy ageing and survival in a cohort of people aged 65 years old and over living in five LAC countries after a follow-up period of 4 years.

#### **2. Materials and Methods**
