• Adults in France that participated in the SU.VI.MAX cohort: Supplemetntation of vitamins and minerals antioxidants study
• Included in eight-year follow-up starting in 1994.

Recruitment

• Subset of volunteers from project were randomly selected.

Design

• Men and women, 45 to 60 years old, reported their food intakes over six non-consecutive days
• Consumers of low-fat and low-sugar foods and drinks and artificial sweeteners were compared with non-consumers.

Intervention

• Volunteers were ascribed to different groups depending on their food intake.
• Non-consumers: No intake over six days of fat-reduced, sugar-reduced or alcohol reduced products.
• Occasional users: One to three days over six days with at least one intake of fat-reduced, sugar-reduced or alcohol reduced products.
• Regular consumers: Three to five days over six days with at least one intake of fat-reduced, sugar-reduced or alcohol reduced products.
• High consumers: Six days with at least one intake of fat-reduced, sugar-reduced or alcohol reduced products.

Statistical Analysis

• SAS statistical package, comparisons of means were performed by analysis of variance, adjusted for age. Data for males and females were analyzed separately.
• Energy intake and macronutrient intake was estimated using the computerized food composition tables and compared with the French Recommended Dietary Allowances. Nutrient density was expressed as amount per 1,000kcal.

Timing of Measurements

• 24-hour dietary record: Subjects record every other month, for a total of six records per year. Provided with a small processing unit with ad hoc software to fill out questionnaires. Types of foods (fresh, frozen, canned, etc.) as well as cooking methods, seasonings, place and time of intake were recorded.
• Biochemical measurements: Obtained at the beginning of the initial visit of the study. 35ml venous blood samples were obtained after a 24-hour fast
• Clinical examinations: Were performed one year after inclusion and included anthropometric data (height, weight, waist and hip circumferences). Data collected from October 1995 to July 1996. 

• Initial N: 12,735 women and men (2,299 men and 1,979 women, aged 35-60 years participated) 
• Age: Women ages 35-60 years, men aged 45-60 years
• Anthropometrics: BMI average was around 25
• Location: Represented eight geographical regions of France.

Other Findings

•  Among women using artificial sweeteners, one-third do not consume sucrose at all.

Low-Sugar Products

• Low-sugar drinks and foods are rarely consumed in this population. Artificial sweeteners are used fairly frequently by 22% of men and 30% of women. Over 15% if the subjects utilize them regulary or often. Nine men (0.4%) and 371 women (19%) used both low-sugar (artificial sweeteners) and low-fat products at least occasionally.
• Male and female users of low-sugar products were heavier, had higher BMI and waist-to-hip ratio
• Male and female users of low-sugar products had higher triacylglycerolaemia and fasting glycemia than non-users.
• Cholesterol values were not different
• Male users of low-sugar products ingested less energy, less protein from vegetable origin, less carbohydrates and less sucrose than non-users. Animal protein intake was higher in high consumers of low-sugar products than in non-consumers and occasional consumers.
• In male consumers of low-sugar foods, the proportions of protein and fat in the diet were linear and significant with frequency use, while that of carbohydrates decreased
  
• In women, intake of vegetable protein, carbohydrates and sucrose decreased linearly with frequency of use of low-sugar intake of animal proteins. The proportion of proteins in the diet also increased with the use of low-sugar products, while the proportion of carbohydrates decreased.

Low-Fat Products

• In all groups, protein and fat intake was higher than recommendataions (proteins about 12% and fat less than 35%). Carbohydrates was less.
• Micronutrient intake: Few differences between users and non-users. No differences in absolute daily intake except cholesterol was consumed in larger amounts by users of low-sugar products.
• Density of the diet was higher in male and female users than in non-users for Vitamis E, riboflavin, B6, niacin, cholesterol, calcium, potassium, magnesium and phospohorus
• Use of low-fat products was associated with no anthropometric differnce in men, whereas female users were heavier than non-users. The BMI in the heaviest groups of women were below the BMI=25 defining obesity. Users and non-users had similar biochemical markers.
• Male users of low-fat products consumed less fat and more carbohydrates than male non-users. The proportion of daily energy intake from fat was lower in high-frequency users of low-fat products. The percentages of proteins and carbohydrates in the diet increased with frequency of low-fat food intake. 
• In women, the use of low-fat products was associated with more protein (especially animal), more sucrose and less alcohol than non-users
  
• Male users of low-fat had higher micronutrient intakes (carotenoids, vitamins C, E and B2 and calcium, magnesium and phosphorus). The density of the diet in most micronutrients was higher in male users of low-fat products.
• Daily micronutrient intake was higher in female users in both absolute and in density, except for vitamins A and D.

In mature adults, the selection of fat-reduced products was associated with improved quality of the diet, while anthropometrics and biological parameters appeared less favorable in consumers of low-sugar products vs. non-consumers. The longitudinal follow-up of the cohoort in future years will help determine a cause-and-effect relationships among these parameters. 

Limitations

• Unlikely massive underreporting behavior observed in the subjects who were obese create biases.
• Differences in energy expenditures could have made some individuals more prone to weight gain and more susceptible to consume energy-reduced products in their diet.