Sunday, May 21, 2017

The Role of Theme Meals in Dietetics

What does planning and organizing a theme meal have to do with dietetics? That was the question I asked myself at the beginning of a 6 week food service rotation. But as my partner and I started the planning, I realized that I was using a lot of information I learned during undergrad classes--like recipe conversions and calculating staffing needs. I also realized that I was gaining a lot of information that will help me as a future dietitian.


Dietitians can play vital roles in food service operations, even as a clinical or community dietitian. I learned a lot about patience, compromise, and trial-and-error from planning our theme meal. Those are valuable life lessons that I’m sure I’ll use throughout my career, even though they’re not specific to the field of dietetics. However, there are components of planning a theme meal that directly relate to being a Registered Dietitian (RD).



Salmon that my partner and I cured for a recipe


Menu Building
The first step in planning our theme meal was building the menu.  We had a basic menu pattern for our meal: two salads, three sides, three entrees, and two desserts. Next we needed to apply our Hawaiian theme and select items that were suitable for our patrons. This was easier said than done. After spending hours upon hours researching authentic Hawaiian recipes, we chose a few selections that we felt would both be nutritionally sound and appeal to the seniors who would eat the meal. Only half of those recipes ended up on our final menu, though.  We eliminated one selection because that certain type of fish was difficult to prepare for mass production; another one was ruled out because a key ingredient would completely blow our budget. This process reminded me of an experience I had working with a patient who was just diagnosed with renal disease;  I suggested a number of foods that fit for his health condition, but each was shot down for various reasons, most often a dislike of the food. The patient and I worked together to craft a meal plan that worked for him, just like my partner and I crafted a menu that fit for our theme meal. I was happy to get this menu building experience because dietitians should be well versed in building well-rounded menus which are suitable for their populations.


Nutrient Analysis and Recipe Evaluation
To plan a successful meal, we needed to convert recipes for mass production, convert ingredients to different units for accurate ordering, and analyze the nutritional value of the recipes. Analyzing the nutritional value of a meal may seem like a no-brainer, but it’s essential for RDs to know how to calculate the nutritional value of a meal without using the crutch of an online tool. And let me tell you--this was a long and tedious task for someone who hasn’t taken a basic math class in 4 years. Now that I’ve had the experience of doing so, I feel competent to calculate a nutrient analysis by hand in the future.



Hawaiian-decorated dining room for the theme meal


Budgeting
A huge component of planning our theme meal was making sure we stayed on budget. Our budget included food cost and decorations. Thankfully, our food service facility managed the staffing, although we did get to play with the puzzle that is building a schedule of employees with irregular availabilities. Budgeting is a skill that, frankly, everyone needs to perfect. As a future RD, I can foresee using budgeting skills in many areas of dietetics, especially in a management role.


Quality Analysis
During our meal, we passed out short surveys to ask customers about their opinion of the meal. After the meal was complete, we collected all of the surveys and compiled the results. We used this data to determine the least and most popular menu items and offer suggestions to future interns planning a theme meal. Quality assurance is a practice that I believe is of utmost importance to being a dietitian. Conducting any kind of quality analysis, whether it be formal or informal, is vital to knowing what you’re doing well and how you can improve.


My partner and I spent many long days working together to carefully prepare and plan for this 2.5 hour event. While the process was not as fun as I thought it would be, I did learn a lot.  I am glad I had this opportunity to develop many skills that I will continue to use as a professional; some directly relate to dietetics and some relate to professionalism in general. Thankfully our Hawaiian theme meal was successful, and despite those stressful weeks leading up to the event, I would do it again in a heartbeat.



Tuesday, May 16, 2017

Nutrition and Food Science Department Poster Day


On Friday, May 5 the UMD dietetic interns had the opportunity to present abstract posters for the University of Maryland’s Department of Nutrition and Food Science Research Day, which was held at the National Agricultural Library.

The day started off with a keynote speaker, Dr. Eric Brown, Ph.D. Dr. Brown is the director of the Division of Microbiology in the Office of Regulatory Science at the Food and Drug Administration (FDA). The topic of his presentation was “The Rise of Whole Genome Sequencing for Food Safety and its Role in Augmenting Traceback of Foodborne Pathogens Back to Their Source.” To put it simply, we learned about the advancements in technology that the FDA is using during foodborne illness outbreaks, such as salmonella, to determine the original source of the bacteria. While the topic is serious, Dr. Brown was able to add an element of humor to this presentation by showing a decision tree for how people determine whether they will eat something they dropped on the ground.  Points to be considered included “did anyone see,” “was the food sticky,” etc.


Dr. Brown and his decision tree presentation slide
After the keynote presentation and lunch, we presented our posters to four judges, all of whom are in the dietetics field. Posters were either in the “case study” category or “special project” category. We spent approximately ten minutes talking with each judge about our posters, explaining our topic, and answering questions.

My abstract poster was about Recovery Record, an application (app) for eating disorder treatment. There are two different apps: one for the clinician and one for the client. The client can log food, feelings and behaviors in their app. The clinician uses the app to see a newsfeed of clients and their current moods, eating patterns, and behaviors. This app can be used for any kind of eating disorder and eliminates the need for a 24-hour food recall or counting on the client’s memory when determining what foods have been eaten recently. The client’s version differs from food trackers in that it does not include  calories, macronutrients, or a food database. Food is entered in as free text and then the client is prompted to document if they ate too much food (binged), an adequate amount of food, or not enough (restricted).  The clinician can easily see progress being made by the patient in a HIPAA compliant app, and can send messages back. The app allows for more frequent communication between the clinician and client between visits. This is important for those recovering from eating disorders. I believe the concept of this app, encouraging mindful and intuitive eating rather than calorie-based tracking, could be successfully used for apps for weight loss and other disease states.

Me (left), Angela, Ben, Tuesday (middle), and Paula (right) with our abstract posters. (Click to view larger.)


After presenting my poster to the judges, I was able to view the graduate students’ posters. The  research poster topics ranged from social determinants of food insecurity to respiratory quotients in men related to blackberry consumption. The event concluded with a poster award ceremony. From our internship class, Angela won the “case study” category with her abstract poster “MNT in Stage 5 Chronic Kidney Disease (CKD): diet instruction with a cultural twist” and I was thrilled to have won the “special project” category with my poster “New Technology Tool: Aid in Eating Disorder Management.”

Me (left) and Angela (right) with our certificates of excellence for our abstract posters.

Friday, May 12, 2017

Hail to the Kidney!


Three years ago while visiting my family in Argentina, I had the opportunity to shadow a renal dietitian at a dialysis center. At that time, I knew little to nothing about the nutritional implications of renal disease or the role the kidney played in maintaining a balance of fluid and chemicals in the body. I learned a little about what a renal dietitian does during that visit, but perhaps more importantly, the exposure piqued my interest.  A few weeks ago, I completed a highly anticipated renal rotation where I learned so much about managing renal disease with nutrition and dialysis.  Nutritional therapy is critical to manage and slow the progression of renal disease from Chronic Kidney disease (CKD) to end-stage-renal disease (ESRD). Once the disease has progressed to ESRD, dialysis or kidney transplantation is required to stay alive. A dietitian can provide nutrition education critical for successful management of ESRD. Two key nutrients of concern in ESRD patients are phosphorus and albumin. These nutrients are the hardest laboratory values to keep within range.
Phosphorus:
Dialysis does a great job in removing the extra potassium and sodium from the body, but it is less effective with phosphorus or “Phos.” It is very important patients know how to control their dietary phosphorus intake.

So, why is phosphorus hard to control for people in dialysis? During my rotation I became aware that phosphorus is ubiquitous in foods. There are natural sources of phosphorus, such as from dairy products, fish and meat; additionally phosphorus is added to most processed foods, such as  Gatorade, twinkies, chocolate pudding, etc. I was able to teach patients how to read food labels to help them recognize and avoid foods that are either naturally high in phos or contain phosphorus additives. They should check the label for long words that contain “phos,” such as “monosodium phosphate,” “dicalcium phosphate,” etc.

Another important topic that I covered with patients was the importance of compliance with phosphate binders. Unfortunately, non-compliance was a common issue.  Since keeping phosphate within normal range is so difficult for most people undergoing dialysis, it is vital that they remember to take phosphate binders with each meal. For that purpose, I had fun delivering key chains designed specifically to carry the phosphate binding pills for patients to use when they will be away from home during meal times.

Albumin:

Another potential problem with ESRD is low blood levels of albumin. It was very unusual to see a patient with a normal level of this protein.

Albumin is the most abundant protein in our body. Our body needs protein to help build muscle, repair itself, and fight infections. Since so many patients on dialysis need to eat a good amount of quality protein, I made sure to discuss how to make good protein choices with the patients. It was very challenging, but critically important to tailor a diet specifically for their underlying disease; the diet typically needed to be high in protein but lower in sodium, potassium, and phosphorus.

After having this experience, I have a clearer understanding of the role the kidneys play in normal bodily function.  Additionally, I realize the importance of regulating key nutrients such as sodium, potassium, phosphorus, and protein when the kidneys are not functioning properly.  I was taken aback with renal nutrition three years ago because of the major impact diet plays in the outcome of this terrible disease. Now, after completing my renal rotation, I understand the complex, but fascinating world of renal nutrition a bit more. I am not only convinced that my true passion lies in renal nutrition, but also about the importance of leading a healthy lifestyle to help keep our kidneys healthy.

Saturday, May 6, 2017

Maryland Day 2017

Saturday, April 29th was the 19th annual Maryland Day!  Each year, the University of Maryland (UMD) invites families, alumni, faculty, staff, students, and prospective students to “Explore [Their] World of Fearless Ideas.”  Maryland Day 2017 offered over 400 events all around campus and had 75,000 visitors!

This year’s Maryland Day featured events at multiple different “learning neighborhoods”:
  • Art & Design Place – The Art & Design place offered theater, music, and dance events, many of which involved getting the whole family up and moving!
  • Biz & Society Hall – Events in this neighborhood helped prepare you for the professional world! The Department of Communication offered events to conquer speech anxiety and improve writing.
  • Science & Tech Way – Learn food safety 101 and the importance of hand washing in this neighborhood!
  • Sports & Rec Row - This neighborhood was all about games, physical activity, and living a healthy lifestyle. It featured a rock wall, family yoga and dance sessions, sand volleyball, gymnastics and acrobatics, elements of a challenge course, and some free health screenings.  Since a good diet is an important part of a healthy lifestyle, the UMD School of Nursing at Shady Grove shared dietary guidance related to obesity, diabetes, and hypertension.
  • Terp Town Center – Everything you can imagine happened in the middle of Maryland’s campus. BikeUMD offered free bike valet for all attendees, there were 1-hour campus walking tours, the Counseling Center offered mental health and wellness sessions, and UMD chefs discussed initiatives to support food security for everyone.
  • Ag Day Avenue – This is where our booth was.  Located in the courtyard of the Animal Sciences Building, our table featured information about portion sizes, sugar sweetened beverages, and how to build a healthy plate. We had information for everyone - from preschoolers to adults!
MD Day 3.jpg  MD Day 1.jpg

We also had a corn hole game for kids! Instead of a traditional corn hole game where the two boards are placed across from each other, our boards were placed next to each other to make it easier for kids to get their bean bags in the holes.  When placed next to each other, our boards illustrated a healthy plate!  The kids had a lot of fun with the game, most of them wanting to play multiple times. Their prizes were a MyPlate coloring book with a word-search and crossword puzzle, and a pack of crayons.

MD Day 2.jpg


People of all ages were interested in our table!  My fellow interns and I greeted visitors to our table and answered their questions on nutrition.  People asked about food myths (i.e. “I heard pineapple was bad for you”) and for more information on how to build a healthy plate.  Many  were shocked at the amount of sugar in sodas and sports drinks. We helped them see why water and unsweetened beverages are a better choice. Our table also featured three examples of healthy plates, complete with food models.  One kid even showed off his food knowledge by naming all the foods on the plates!  We gave our visitors handouts to take home and hopefully inspired them to eat a healthier diet.
MD Day 4.jpg

I really enjoyed my time at Maryland Day.  I had fun playing with the kids and teaching people about nutrition.  As a bonus, I even got to take home an herb plant which I’ll use in cooking endeavors! For more information about Maryland Day or to see the hundreds of events you might be able to expect next year, visit: https://marylandday.umd.edu/index.html.