Background: Identifying factors associated with cognitive impairment among older adults is critical. This study aims to examine associations of fruit and/or vegetable intake (FVI), sleep quality and duration, and their interactions with cognitive performance among older adults in China.Methods: We utilize nationwide datasets in 2008 and 2011 in China to examine associations between sleep quality and duration, FVI, and cognitive impairment. Interactions between sleep and FVI on cognitive performance are also examined. All analyses are further stratified by gender, age group, and urban-rural residence.Results: When all covariates are fully adjusted for in the cross-sectional analyses, frequent FVI is associated with a 29% lower risk of cognitive impairment compared with less frequent FVI, and daily sleeping durations of ≤6h and ≥10h are associated with a 13% and a 51% higher risk of cognitive impairment, respectively, as compared with the duration of 8h. Sleep quality is not significantly associated with cognitive impairment compared with fair/poor sleep quality when all covariates are adjusted, though it is associated with a 31% lower risk when only demographics are controlled for. Interaction analyses reveal that frequent FVI offsets the higher risk of cognitive impairment for poor sleep quality and excessive sleep durations. Subgroup analyses show a generally similar pattern for both sexes but a more pronounced association for young older adults than for oldest-old adults. The patterns of the interactions of FVI, sleep quality, and sleep duration with cognitive impairment differ by urban-rural residence. However, associations of good sleep quality, adequate sleep duration, and frequent FVI with the incidence of cognitive impairment over a 3-year follow-up period are mostly not significant. Conclusions: The positive association of good sleep quality, appropriate sleep duration, frequent FVI, with good cognitive is mainly cumulative or long-term. Frequent FVI could offset a higher risk of cognitive impairment for poor sleep quality and/or excessive sleep durations. The associations are similar for both sexes but are stronger in oldest-old adults and differ by urban-rural residence.

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