Objective: To review the evidence on the association between fruit and vegetable (F&V) consumption and risk of chronic disease, and to assess trends in the prevalence of low F&V consumption. Design: Systematic review and cross-sectional analyses of a Mediterranean cohort. Setting: The Seguimiento University of Navarra (SUN) project (Spanish dynamic cohort of graduates). Subjects: A systematic review of prospective studies aimed to assess the relationship between fruit and/or vegetables consumption and chronic disease incidence was conducted. We also assessed 18 457 university graduates (59?4 % women; mean age 5 39 (SD 12) years) enrolled in a dynamic cohort with permanently open recruitment. Baseline data were collected between 1999 and 2010 using a validated 136-item FFQ. Four definitions for low F&V consumption were used (,400 g/d, ,200 g/4184 kJ (1000 kcal) per d, #2 servings/d and #1 serving/d). Multivariate-adjusted cross-sectional associations between the prevalence of low F&V consumption and the year of recruitment were estimated. Results: The systematic review found that a high F&V consumption is inversely associated with CVD incidence and mortality. This association is not so clear for cancer. Inconsistent findings have been reported for diabetes. In all, 13 % of participants in the SUN cohort did not meet the goal of consuming at least 400 g/d of F&V and 2?1 % of them did not reach .1 serving/d. Between 1999 and 2010 the consumption of F&V significantly increased. Conclusions: Even among health-conscious university graduates, low F&V consumption is fairly prevalent. Although the temporal trends suggest an improvement, preventive strategies addressed to increase F&V consumption are needed.