The Impact of a Virtual Educational Cooking Class on the Inflammatory Potential of Diet in Cancer Survivors

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript by Jackson et al. deals with the evaluation of the impact of an educational cooking course on the eating habits of cancer survivors and on the possible increase in the anti-inflammatory potential of the modified diet. Furthermore, they attempted to correlate changes in diet with changes in cognitive cognition.

The vulnerability of cancer survivors to nutrient-poor diets is well documented, as are the nutritional consequences of anorexia, dysgeusia, and dysphagia, which are common consequences of cancer therapy. Studies are therefore needed to evaluate the impact of education on diet quality.

The topic of the manuscript is interesting, but the reported study has several weaknesses.

First, although fiber intake and dietary inflammatory index (DII) are important characteristics of the diet, it is not entirely clear why AUs focused their attention only on these two parameters. In fact, cognitive decline is not only linked to inflammation. Undernutrition itself is a key risk factor in cognitive decline (see Ward et al DOI: 10.1136/bmjopen-2022-070689). Other food intakes should have been considered individually and not aggregated in the DII.

The study population was very small (n=22) and included 100% white females. These are significant limitations even for a pilot study and make the results not completely reliable. Furthermore, the majority of subjects had a high educational qualification (87%), which is known to be a confounding factor in the educational intervention.

The educational intervention was limited (a 30-minute virtual cooking lesson) without any assessment of the participants' knowledge acquisition and correct understanding of the knowledge inputs.

It is unclear why only 30 of the 45 parameters included in the DII calculation were available. Since the focus was on the relationship between DII and cognitive impairment, the diet history questionnaire would have to be modified to capture all of them.

Median cognitive factor scores at baseline were very low for all scores except COG-PCA. In particular, COG-PCI and COG-OTH were so low as to suggest misperception. Have the AUs considered verifying these findings using other methodologies to assess cognitive impairment?

 Overall, the nutritional intervention did not improve the quality of the diet for the parameters considered. Fiber intake decreased significantly and consumption of fruits, vegetables, nuts and whole grains did not change. The significant reduction in energy intake cannot be classified as "positive" as it depends on the anthropometric characteristics of the individual subject, and a decrease in subjects with a low BMI is negative. Although the median BMI was 28, the interquartile range was wide. To evaluate the positivity of a reduced E intake, volunteers should be divided into overweight, normal and underweight.

Parameters that lead to significant decreases in E-DII scores should be reported.

 Although there were significant increases in FACT-Cog subscores following the cooking class intervention, it is difficult to link these to the intervention itself and, consequently, to a subsequent dietary modification. The results could be distorted simply by a better perception of oneself and one's abilities linked to having participated in the intervention. The reported correlations seem more like a statistical exercise than robust results.

Overall, although it is plausible that the use of cooking classes is an effective educational technique for improving the eating habits of cancer survivors, this study is far from proving that it can contribute to the improvement of cognitive dysfunction.

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors,

There is evidence to suggest that cognitive dysfunction is prevalent among cancer survivors. One of the causes that impair these functions is inflammation. However, an appropriate diet plays a significant role in mitigating cognitive issues.

The article intends to assess the impact of an educational cooking class on cancer survivor eating habits and their inflammatory potential and determine the relationship between diet and cognitive function. Existing reports on this topic may help to conduct interventions based on complex scientific data. These data should be gained from reliable research. The review has scientific and practical importance in the medical and food fields. The review is prepared according to the journal's requirements and within the subject matter's scope. The structure of the manuscript is correct. The title matches the paper's subject. The Abstract is correct, presenting the main results of the research and conclusions. The Introduction presents the subject and the objective of the study. The methodology is well adapted to the objective, and the results are interesting. The discussion is presented correctly, using recent, properly chosen scientific literature.

You have to insert some information about the limitation of using self-reported data for weight and about the correctness of the comparison between measured and self-reported weight. Calculation of BMI based on declared body mass limits the reliability of results in this area.

Statistically insignificant p-values do not need to be included in the table (ns).

 

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Dear Authors:

This article entitled " The Impact of a Virtual Educational Cooking Class on Inflammatory

Potential of Diet in Cancer Survivors" is quite interesting and has a great impact in the area of adult health and cancer.

Introduction

I consider that the information is correctly.

Material and method

It is suggested to add as inclusion criteria, if possible, the percentage of attendance to the cooking sessions.

Result

I consider that the information is correctly displayed, but I suggest that if you have an data on water consumption of patients are available, you should be placed on the table where the characteristics are described.

If it is possible to put a mathematical relation between water intake and gr/fibre, as it is important in the functioning of the intestine and you should also discuss it.

Check carefully this paragraph that is in red, as it appears as if it was a copy paste when placed in an anti-plagiarism program (Attached document).  

Discussion

I consider that the information is correctly.

Conclusion

I consider that the information is correctly.

Comments for author File: Comments.pdf

Author Response

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Author Response File: Author Response.pdf