INTRODUCTION
Dietary antioxidants function to protect the body from chronic diseases [
12] such as cardiovascular diseases, diabetes, and cancer by removing free radicals (ROS) and controlling LDL oxidation [
3]. Plant foods contain a wealth of dietary antioxidants such as vitamin C, vitamin E, carotenoids, and phenolic compound. It is widely known that taking in a large quantity of fruits and vegetables increases the activity of a human body's antioxidant defense system, contributing to preventing chronic diseases related to oxidative stress [
4567].
Since Korean diet (KD) consists traditionally of side dishes including soup and plant foods in addition to boiled rice, it features a high content of carbohydrate, low content of fat, and rich plant ingredients [
8910]. Nutritional epidemiologists have reported that the plant food-centered dietary patterns of Koreans are advantageous in reducing the risk of chronic diseases [
1112131415]. This is probably because Korean food menus consist mainly of plant foods such as whole grains, fruits, vegetables, and seaweeds, which contain a wealth of elements that involve antioxidant activity. The Mediterranean diet [
16], which is well-known for its effect to reduce the risk of chronic diseases, has been reported to show outstanding antioxidant activity, and thus it is expected that the antioxidant activity of KD would also be quite significant. Existing researches on the excellence of KD include studies on its nutritional epidemiology that clarifies the relation between Korean dietary patterns and chronic diseases [
11], case-control studies [
17] that examine the Korean dietary patterns of normal individuals and patients and their relations with the risk of diseases, and nutritional intervention studies [
18] that observe changes in the risk of chronic diseases after the KD. In contrast, there have been few studies focusing on the antioxidant activity of the KD especially in relation with its DNA damage reduction effect.
Existing researches at home and abroad on antioxidant activity focus mainly on individual foods or specific components [
19]. Antioxidants in food may lead to synergy or inhibitive activity depending on whether they are mixed harmoniously when taken in. In order to compare Korean and American diets in terms of antioxidant activity, therefore, it is of significance to examine a food group or a whole menu rather than individual foods. However, there have been few studies both at home and abroad on the antioxidant capacity of a whole diet or a dietary pattern rather than of individual foods. Yang et al. [
20] utilized the data of the National Health and Nutrition Examination Survey (NHANES 2001-2002) in order to analyze the level of antioxidant capacity that is common in American diet. They estimated the total dietary antioxidant capacity of a whole diet in reference to the food data of this diet recall survey and existing measurements of each food's antioxidant capacity. Russnes et al. [
21] examined foods that the Spanish population would take in by means of the food frequency questionnaire (FFQ), and then they estimated the total dietary antioxidant capacity of a whole diet in reference to the existing FRAP value data of each food to analyze correlation with prostate cancer. Recently, the result [
16] of the
in vitro measurement of the total dietary antioxidant capacity in the Spanish Mediterranean diet has come out. The author et al. have measured and reported the antioxidant activity and phenolic content in KD, not those of individual foods that are included in KD [
22].
In general, foods that feature a high level of antioxidant activity or a high phenolic content have outstanding DNA damage reduction effects, and such foods contribute to controlling cancer cell reproduction or preventing chronic diseases [
232425]. There are a number of nutritional intervention studies that specify the relation between dietary patterns and DNA damage reduction effects [
262728].
In an experiment, a healthy diet with vegetables and PUFA-rich plant oil was applied to patients with type 2 diabetes for 8 weeks and, as a result, DNA damage was reduced [
2628]. It was also reported that a menu with a wealth of whole grains, fruits, and vegetables in daily life can reduce DNA damage due to oxidative stress [
27]. Such researches demonstrate that foods of high antioxidant capacity or diets with such foods can protect DNA from damage and control oxidative stress. However, there has been no research on the effect of KD on human DNA damage reduction.
Thus, this study aims to examine the in vitro antioxidant capacity and ex vivo lymphocyte DNA damage reduction effect of KD in comparison with those of American diet (AD) in order to clarify the excellence of KD in terms of antioxidant activity.
DISCUSSION
A traditional Korean menu consists mainly of boiled rice, soup, and side dishes. Rice is boiled with mixed grains such as barley and millet, while soup is made of various ingredients such as meat, fish, vegetables, etc. Side dishes include kimchi, which is a major fermented food, vegetables, meat, shellfish, etc. [
37]. As the Korean society is industralized, however, the dietary composition of Koreans changes gradually: The traditional dietary pattern of carbohydrate and plant foods is changing with healthy Korean dietary patterns of grains, vegetables, fruits, eggs, fish, and dairy goods in the proper ratio. In fact, there is no specific concept of what is a typical Korean dietary pattern.
Recently, many researches on the relation between Korean dietary patterns and the risk of chronic diseases have been released [
111415]. In addition to such observation studies that classify dietary patterns and observe risk factors of chronic disease, intervention studies that observe changes in risk factors of chronic diseases after letting subjects have KD meals for a certain period of time were also conducted recently [
1213]. Jung et al. [
12] observed changes in risk factors of cardiovascular diseases after letting a group of patients with hypertension and diabetes maintain KD for a certain period of time. This study applied the “Korean traditional diet” (total content of fat: 19%) that was common in the 1970s. The meal includes boiled rice and at least three side dishes of soup, kimchi, and fermented foods (made from fermented beans). It may include raw or cooked vegetables, steamed or roasted fish or meat, dried and preserved foods, etc. The menu of the control group included American dietary items such as bread, milk, and dairy goods and was prepared according to the basic principles of diet suggested by the Korean Diabetes Association. These two different menus were served to patients with hypertension and diabetes for 12 weeks. As a result, the group to which the KD menu was applied showed positive changes in risk factors of cardiovascular diseases such as blood pressure, BMI, waist measurement, heart rate, LDL cholesterol, etc. Schroeder et al. [
13] provided adults who were overweight and obese (risk factors of cardiovascular diseases) with the KD menu, Dietary Guidelines for Americans (DGA), and the typical American diet (TA) for 4 weeks in order to examine the effect of Korean dietary patterns. The KD menu included five food groups: grains (whole grains and refined grains)/meat, fish, eggs, beans/vegetables/fruits/milk, and dairy goods in consideration of the dietary composition recommendation of 2010 KDRIs. The menu of the 2010 DGA is recommended by the U.S. Department of Agriculture. It presents various dietary patterns with vegetables, fruits, whole grains, fiber, seaweeds, lean meat, beans, nuts, low-fat dairy goods, and so forth. The TA consists of foods that Americans commonly take in. This menu was prepared based on the result of the NHANES. The percentage of vegetables, fruits, whole grains, fiber, and dairy goods is relatively low while the percentage of sodium, saturated fat, and refined grains is high. One nutritional intervention study [
13] included a 4-week experiment, where the total cholesterol level and LDL decreased in the KD and DGA groups.
According to one case-control study on the relation between Koreans' dietary patterns and colorectal cancer, the Traditional pattern incorporating vegetables, mushrooms, seaweeds, beans, and fish and the Prudent pattern using fruits, milk, dairy goods, whole grains, nuts, and kimchi decreased the risk of colorectal cancer because of the intake of many fruits and dairy goods [
17]. It may be difficult to summarize such existing research findings in a few words, but in general, traditional KD menus that present carbohydrate, protein, and fat in the proper composition ratio or the Acceptable Macronutrient Distribution Range (AMDR) and include a large amount of grains, vegetables, fruits, kimchi, seaweeds, fish, beans, and fermented foods have positive effects in preventing risk factors of chronic diseases, compared to Western diet menus that center on fat and protein.
The above-mentioned studies all show the relation between the risk of chronic diseases and Korean dietary patterns while there are few researches on the antioxidant activity of KD. It is well-known that when the antioxidant status is improved, oxidative stress decreases and then the risk of chronic diseases decreases accordingly. Thus, if the antioxidant activity of subjects had been analyzed in the studies mentioned above, there would have been positive results. In addition, although the Korean dietary patterns in nutritional intervention studies above were different, most of them were a type of Korean healthy diet. Accordingly, this study, which compares the antioxidant activity and DNA damage reduction effect of KD with those of AD, applies the KD menu suggested by the 2010 KDRIs as a Korean healthy dietary pattern. This menu was prepared with six food groups: grains, meat/fish/eggs/beans, vegetables, fruits, milk/dairy goods, and oil/sugars. Each meal contains an amount of food recommended for one individual each day.
In this study, the average value of in vitro antioxidant activity of the KD daily meals measured by means of the ABTS assay was higher than that of AD. As for the one-week meals that combined all the daily meals as well, those of KD showed a significantly higher level of antioxidant activity than those of AD when measured by means of the phenolic content analysis method (P < 0.05), DPPH radical scavenging capacity (assay) (P < 0.001), and the TEAC assay (P < 0.01). This result indicates that the antioxidant capacity of KD is superior to that of AD. However, one-week meals of both KD and AD consisted of different foods each day, and their levels of antioxidant activity were also different accordingly. Further, it may be difficult to affirm that the one-week meals used in this study are typical menus of KD and AD. Thus, it is necessary to compare the antioxidant activity of KD and AD in a broader range for a longer period of time. Still, this study is of significance in that it attempts to measure the level of antioxidant activity of combination diets in comparison of KD and AD while existing domestic and foreign researches on food antioxidant activity focused on individual foods or specific ingredients of individual foods while there have been few attempts to measure the antioxidant activity of one meal with various kinds of foods, one-day diets with three meals and one snack, or one-week diets that combine menus for each day. Studies on the antioxidant capacity of one meal and one-day, one-week, or one-month diets need to be conducted continually in a broader range.
The ratio of plant foods in the KD is higher than that of AD. In particular, plant foods in KD such as fruits, vegetables, mushrooms, seaweeds, nuts, potato, grains, beans, kimchi, and oils contribute a lot to its relatively high level of antioxidant capacity [
22]. As for the quantity of vegetables and fruits in the KD and AD used in this study, the average amount of vegetables and fruits (including fruit juice) per day in the case of KD was 586 g while that of AD was 339 g, which indicates that KD includes more vegetables and fruits in each meal compared to the AD. It is thought that such differences in dietary patterns result in a different level of antioxidant capacity.
Other dietary patterns that present a sufficient amount of fruits, vegetables, and whole grains and thus feature a high level of antioxidant capacity are those of the Mediterranean diet. To examine the effect of Mediterranean dietary patterns on the state of antioxidant capacity, Zamora et al. [
38] conducted a nutritional intervention study among subjects in their 50 to 80 s with risk factors of cardiovascular diseases (smoking, hypertension, use of hyperlipidemia drug, obesity, etc.) for one year. As they measured the antioxidant capacity of plasma thereafter, the level of plasma Non-enzymatic Antioxidant Capacity increased. This result indicates that the Mediterranean diet consists mainly of plant foods of great antioxidant capacity such as fruits, vegetables, nuts, and whole grains unlike other diets [
16]. KD is similar to the Mediterranean diet in that both are in a high level of antioxidant activity [
22], but a deeper study needs to be conducted on other aspects that show the excellence of the KD.
There have been a number of studies on measuring the effect of DNA damage reduction of food extracts by means of the comet assay where lymphocytes were separated, food extracts went through the pre-treatment, and DNAs were intentionally damaged by means of H
2O
2 [
23]. Many view that this kind of
ex vivo experimental method is advantageous, compared to other common
in vitro experimental methods, in applying it to human bodies [
39]. Hence, this study adopts the
ex vivo method using lymphocytes to examine the DNA damage reduction effect of one-day meals and one-week meals of KD and AD in the way of comet assay. The comet assay experiment produced two interesting results: First, there was difference in DNA damage reduction effects among the days of the week in both KD and AD, and this difference was more significant than that among
in vitro experimental methods. This indicates that
ex vivo DNA damage protective effect may be far more sensitive than the
in vitro antioxidant activity depending on the daily diet in this study. In general, it is also viewed that
ex vivo DNA damage reduction effect is a more sensitive parameter than
in vitro antioxidant activity. Thus, the comet assay that utilizes lymphocytes is better than common
in vitro assay methods in measuring food's antioxidant capacity.
Second, in both daily meals (
P < 0.001) and one-week meals of diet (
P < 0.01), the DNA damage protective effect of KD was significantly higher than that of AD. This result can be a basis for future study to demonstrate the excellence of KD in terms of antioxidant activity. It has been reported that foods of outstanding antioxidant activity show a relatively high level of DNA damage protective effect [
2324]. According to Park et al. [
23], flavonoid compounds and antioxidant vitamins show a high level of DNA damage protective effect, and foods of a high level of DNA damage protective effect play an important role in preventing cancer or chronic diseases. Gafrikova et al. [
24] measured the protective effect on DNAs damaged by H
2O
2 after the pre-treatment with flavonoid elements (kaempferol or quercetin) of horseradish and Armoracia rusticana extract (AE). As a result, it turned out that as for AE, DNA damage was reduced from 78% to 35.75% while as for kaempferal and quercetin, DNA damage was reduced from 83.3% to 19.4% and 16.2% respectively. A number of existing researches demonstrated that there is a high correlation between phenolic content and antioxidant capacity [
1622]. In addition, Jayakumar and Kanthimathi [
25] reported that as the phenolic content of various spices was high, the DNA damage protective effect, as well as cancer cell reproduction control effect, were high accordingly. Such studies correspond to the finding of this study that the phenolic content, antioxidant activity, and DNA damage protective effect of KD are all better than those of AD.
Switzeny et al. [
28] conducted an experiment among patients with type II diabetes where they maintained the diet with 300 g of vegetables and 25 mL of vegetable oil at each meal for 8 weeks, and the extent of DNA repair was analyzed. As a result, it turned out that the rich antioxidant substances in the meals removed free-radicals and increased the level of DNA restoration compared to the baseline. In addition, this study demonstrated a high level of correlation between DNA strand breaks and the methylation level as well. These findings verify that foods and dietary patterns of high antioxidant capacity can protect DNAs from damage and control oxidative stress. These studies correspond to the finding of this study that KD can enhance antioxidant activity compared to AD, and that the former can protect DNAs from damage by H
2O
2, having many health benefits.
However, this study has limitations in that it uses the one-week menus as samples of KD and AD to show the antioxidant activity and DNA damage reduction effect, but one week is insufficient to represent the typical dietary patterns of KD and AD. Since we eat different foods every day, either in KD or AD, it is difficult to compare KD and AD only based on one-week menus. Thus, a future study needs to prepare menus of KD and AD for a longer period to measure the antioxidant activity and DNA damage reduction effect.
This study aims to measure the
in vitro antioxidant capacity of KD and AD, compare the DNA damage reduction effect, and clarify the excellence of KD. The findings of this study are of significance in that the excellence of KD is proven not only in terms of antioxidant activity but also DNA damage reduction effect on lymphocytes, which is methodologically more sensitive. However, more study needs to be conducted to verify if
in vitro and
ex vivo experiments would produce the same results in
in vivo or nutritional intervention studies [
23]. Thus,
in vivo study needs to be conducted to demonstrate if KD substantially increases the level of plasma antioxidant capacity or decreases DNA damage in lymphocytes. Nonetheless, the findings of this study can be used as a basis to further prove the chronic disease preventive and curative effects of KD demonstrated in a number of former researches. In addition, this study measures the dietary antioxidant capacity and DNA damage reduction effect of KD not for individual foods but for one-day or one-week meals of diet. Thus, this attempt will be an important turning point for future studies on the antioxidant functions of the KD.