## 4 Discussion  
In this pilot interventional study, cancer survivors were able to significantly decrease their inflammatory potential of diet and improve cognitive function scores after one-month post-educational virtual cooking class. Notably, our study is among the first interventional studies to bridge the interconnected areas of diet, inflammation, and cognition, in the context of cancer survivors, where applied education models of improving diet may represent a feasible and accessible intervention for improving cognitive deficits. When examining specific dietary changes related to the education provided, participants were able to maintain a consistent intake of key dietary components, including fruit, vegetables, whole grains, and nuts/seeds/legumes, while creating a significant calorie deficit. Additionally, specific areas of subjective cognitive function were correlated with dietary factors of calorie intake, fiber, fruit, and E-DII scores. After adjustment, change in calorie intake over one month was a predictor of a participant's improvement in perceived cognitive abilities. Our findings show short-term improvement in the inflammatory potential of diet, through a decrease in E-DII scores after one month. Of the sparse interventional DII studies, there has been one investigation incorporating cooking classes to impact health outcomes. [PERSON] et al. designed an intervention consisting of weekly nutrition education and cooking classes vs. printed educational materials with the objective of improving dietary inflammation (DII scores), systemic inflammation (CRP levels), and lipid levels in adults without chronic disease [23]. In this population, the intervention group was able to improve their DII scores after three months of weekly active education, although this was not sustained at a follow-up in month 12. These findings suggest that further research should investigate the optimal duration of nutrition and cooking education to create sustainable changes in dietary inflammatory potential over time. While statistically, there was a 1.5 g decrease in fiber intake between the baseline and one month post-intervention, this may not represent a clinically relevant deficit, as it would be similar to the fiber content of one-third of an apple [52], and, therefore, may be interpreted as consistent intake. Similarly, when analyzing the pattern of change in fiber intake, it was found that most participants with a high consumption of fiber at the baseline continued this intake level at one-month post-intervention, and the majority of those who had lower baseline fiber consumption continued to have a low fiber intake. Despite the consistent fiber consumption patterns, it is worth noting that over 30% of the study population was able to increase fiber in any amount after the cooking class. While our study did not significantly improve fiber, fruit, vegetable, whole grain, or nuts/seeds/legume intake, there was a significant reduction in calories, without compromising the intake of these nutrient and fiber-rich foods. The AICR recommends maintaining a healthy weight after a cancer diagnosis while promoting adherence to nutrient-rich dietary patterns [27]. It is known that excess body weight is a risk factor for cancer recurrence, an overall higher mortality risk, and other chronic disease development, like diabetes and heart disease [53; 54]. As our cohort was primarily overweight, our intervention may represent a way to promote modest calorie reduction while preserving nutrient-rich food intake, for the promotion of healthy weight attainment. Conversely, it is essential to emphasize that while dietary intake, including fruit and vegetable consumption, was maintained and was similar to the national average intake [55; 56], these values still fall short of the recommended Dietary Guidelines for Americans [57] and AICR cancer prevention guidelines [27], providing further evidence that this population is at nutritional risk and can benefit from further nutrition interventions.