**1. Introduction**

Fruit and vegetable consumption has consistently been associated with beneficial effects on health [1,2]. Several meta-analyses have indicated a reduced risk of non-communicable diseases such as cancer [3], stroke [4], diabetes [5], hypertension [6], and heart diseases [3]. According to the WHO, 16 million disability-adjusted life-years (DALYs) and 1.7 million deaths worldwide are attributable to low fruit and vegetable consumption [7]. High fruit and vegetable intake has been associated with a reduced risk of all-cause mortality [8,9] due to cardiovascular diseases (CVD) [10], but also to other non-cardiovascular diseases [11], such as cancer [12], although findings are inconsistent [13].

Many public health guidelines recommend a daily intake of a minimum of five servings per day of fruit and vegetable, although these recommendations vary across regions. For example, the Eurodiet core report [14], the World Cancer Research Fund [15], and the WHO/FAO [16] recommend at least 400 g/day, 600 g/day in Denmark [17], and 640/800 g/day in the USA [3].

Older adults have unique nutritional needs that might require special adaptations of the nutritional clinical guidelines and public health policies addressed to this population [18]. Chronic diseases, multimorbidity, and geriatric conditions such as polypharmacy, mobility-difficulties, and oral problems, are common in older adults and might be associated with malnutrition [19]. The majority of studies of the health benefits of fruit and vegetable consumption have traditionally focused on children, adolescents, or young adults, but few have included older adults [18]. These few studies seem to sugges<sup>t</sup> that fruit and vegetable intake can prevent the onset of depression [20], cognitive decline [21], disability [22], and frailty [23], and can decrease the risk of disease-specific and all-cause mortality in this population [18]. Moreover, the potential benefit of fruit and vegetable intake in reducing the risk of mortality in older adults might depend on various circumstances. For example, a study conducted in several population-based cohorts from Eastern Europe [24] reported that fruit and vegetable consumption was strongly and inversely associated with risk of total and CVD mortality among smokers, compared with non-smokers.

The present study sought to determine the association between different levels of fruit and vegetable consumption and risk of all-cause mortality in a representative sample of Spanish community-dwelling older adults and to determine potential moderators of this association, including multimorbidity and other lifestyle factors such as smoking, alcohol consumption, and physical activity.
