My name is Jay Patruno (he/him/his), RDN, LDN, CPT, CNC. I am originally from Western Massachusetts, and went to school for my undergraduate in nutrition and dietetics (i.e. my didactic program in dietetics) at Boston University. I completed my dietetic internship at Brigham and Women’s Hospital in Boston, MA, and started my career as a clinical dietitian there afterward before transitioning into lower levels of care for eating disorder treatment. After some pivots in my professional career, my personal life took me to South Florida in early 2021 where I now reside. I currently work as the Experimentation Manager and Nutrition Strategist for Orangetheory Fitness Corporate Headquarters.

I actually started my graduate degree with Johnson and Wales University (JWU) in 2020 in the Sports Leadership program. Areas of practice I am particularly passionate about are eating disorders and sports nutrition, which have a lot of overlap. I believe in affirming and compassionate nutrition care, so everything I do I bring a lens of eating disorder prevention and treatment into my practice. I am sure you will hear/see me commenting on aspects of diet culture, weight inclusivity, and nutritional messaging throughout this course. Sadly, I needed to withdraw from JWU before moving to Florida for personal reasons. Now, I am back pursuing my degree in the nutrition science program. I am enrolled in this particular course because it was what was being offered in my required curriculum for this semester.

Something else that is worth mentioning in this introduction, as I will highly likely be talking about it throughout this course, is my passion and advocacy work for diversity, equity, and inclusion (DE&I) in the field of nutrition and dietetics. I currently sit as a Chairperson for the Boston Alliance for Diversity in Dietetics (BADD), and I have given and continue to give lectures and presentations on DE&I related to nutrition practice across the country.

I am very excited to be diving back into the nuts-and-bolts of nutrition science. I look forward to getting not only a refresher in the content but being able to learn with a different perspective than my first time around, and being challenged to learn new things that I may apply to my practice. In reviewing the table of contents of the textbook for this course, I am particularly interested in the week three content on vitamins A, C, E, zinc and selenium, and the overall review of digestion. I absolutely love anatomy, and I really nerd-out over the human body as a “machine”. For this first week in this course, diving into chapter 6 will really get my attention. The aforementioned micronutrients I am particularly interested in because they relate a lot to my current job. I spend a lot of time working with our Medical Advisory Board at Orangetheory Fitness reviewing and vetting nutritional products (e.g. bars, powders, drinks, etc.) for retail sale. The media has really heightened “immunity” as a health goal, and antioxidants are getting a lot of praise right now. There isn’t a robust amount of research for the impact of antioxidants on ergogenic performance, and in general I typically don’t recommend clients buy products with greater than 100% daily value for any micronutrients unless clinically warranted. Manufacturers, though, are taking advantage of the media’s influence and putting a lot of “stuff” in their products with health claims that they boost health, or increase metabolism, or increase immunity. Reviewing the roles and pathways for vitamins A, C, E, zinc, and selenium I think will aid in my ability to determine, at a national level, how to educate and communicate about the role for these nutrients for our company’s membership base.

Please take a look at the photos I posted in this week’s Padlet column of my portfolio to get a little insight into my life. I am a full-time dog-dad. I have two fur baby’s, Hamilton who is a French bulldog and Hugo who is a Boston terrier. If I am not working or studying, I am spending time with them or tending to one of their many high maintenance needs.

Things that I believe this article does well are:

However, when I go to a website like the National Kidney Foundation’s  I expect things to be more tailored to what the expected audience would be. In my opinion, the expected audience would be individuals with some form of kidney dysfunction or kidney disease, someone who is a caretaker for an individual with kidney disease, or a clinical professional caring for someone with kidney issues. 

Although this article does give a general overview of protein, it doesn’t dive into considerations for kidney disease or why various kinds of protein are important to consume versus those to avoid in kidney disease. It doesn’t comment on the various needs someone with kidney disease has for protein either, or what happens with protein needs during various forms of treatment (e.g. while on dialysis, pre- or post-transplant, etc.).

One more thing that surprised me in a negative way was how this article didn’t link-out to other sources that dive deeper into the aforementioned topics that would tailor protein intake education to the kidney disease state. The only resource embedded in this article was one that explains the various stages of chronic kidney disease. This makes me question the strength of the National Kidney Foundation’s editorial platform. Instead of this article providing next steps for someone to dive deeper into protein intake in the setting of kidney disease, it leaves them to toggle back to other areas of the website to find what they think they need versus being guided with intention from article-to-article to build upon their learning while on the site.

Overall, though, I do think the website in its current state is really inviting and easy to navigate. The way things are laid out makes sense, in my opinion, and I would think it is a user-friendly resource to direct clients and patients too. My critiques above are strictly on the article in question.

Ulerich, L.M. (2018, Aug 22). Breaking Down Dietary Protein: What is it?. National Kidney

Foundation. https://www.kidney.org/newsletter/breaking-down-dietary-protein

My mother is a 44 year old female who is lightly active during the week but works a sedentary job. She lives alone and cooks for herself. Historically, she relied on me to cook and promote variety at home since she feels she is not as creative in the kitchen. To align with the Healthy U.S.-Style of Eating and also provide education about what her actual needs are for water, sodium, and potassium, I wanted to create a worksheet thought outlines the following:

Water estimates come from the 35mL/kg for adults as stated in Sheng (2019). The assumption is made that since Sheng (2019) states most sodium intake is in the form of sodium chloride, that by educating and reducing sodium intake overall chloride intake would also be impacted to a relatively equal degree. Therefore, chloride is not focused on this client-facing document but rather the focus is on foods and food groups. Although I am using my mom as the persona for this week’s CCIP, I think her situation is not atypical for many adults (men and women) and this type of client resource could be used with a variety of populations. I feel that visuals, colors, and scaling things can make educating a variety of client types easier and makes things more easily translated into other languages.

Food and Nutrition Service. (2011, Sept 1). USDA Food Patterns. United States

Department of Agriculture. https://www.fns.usda.gov/usda-food-patterns 

Sheng, H.P., Caudill, M.A. (2019). Sodium, Chloride, and Potassium. In M.H. Stipanuk & M.A.

Caudill (Eds.), Biochemical, Physiological, and Molecular Aspects of Human Nutrition (4th ed., pp. 788-805). Elsevier.

Sheng, H.P. (2019). Body Fluids and Water Balance. In M.H. Stipanuk & M.A. Caudill (Eds.),

Biochemical, Physiological, and Molecular Aspects of Human Nutrition (4th ed., pp. 806-823). Elsevier.

United States Department of Agriculture, United States Department of Health & Human

Services. (2020, Dec). Dietary Guidelines for Americans, 2020-2025 [PDF]. Dietary Guidelines.gov. https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf 

I noticed that in many of the resources I referenced they only discuss vitamin D and calcium. Despite our textbook giving good evidence for the roles of magnesium and phosphorus, I decided to focus my CCIP on vitamin D and calcium for two reasons. The first reason is that phosphorus is ubiquitous in the diet and it is more likely that Americans are overconsuming phosphorus compared to recommendations than they are under-consuming it (Shpases, 2019). The second reason is that in reviewing all of the functions of magnesium, Vormann and Kolisek (2019) relate much of the impact it has on bone health being related to how it is a similar cation to calcium and therefore interacts with calcium and its functions at the cellular level (e.g. calcium absorption, being a cofactor for hundreds of enzyme reactions, calcium channel controlling, etc.). The primary role of fluoride, though stored in skeletal pools, was more focused on teeth versus long-bone or axial bone health (Whitford, 2019). For all these reasons and the client demographics outlined above, I decided this CCIP on osteoporosis would highlight primarily vitamin D and calcium from a nutrition-perspective.

I liked that this week we were encouraged to bring in some aspects of exercise, which is supportive for bone strengthening, as well as other lifestyle factors. I imagined this educational resource I drafted for this week’s CCIP to be informing on “what” allows osteoporosis to develop, “what” makes bones healthy in the first place, and “what” can be done to promote overall bone health. The latter is where I wanted to add in lifestyle habits that should be avoided or promoted. Unlike in previous weeks where I have had multiple documents to upload into Padlet in creating the CCIP, this time I created one big document that contains all my thoughts, notes, and references that can be used to create a finalized version, potentially, for the final. I used APA citations at the beginning of each section because all my notes and summaries are a conglomeration of multiple sources. Instead of resorting to AMA formatting for ease-on-the-eyes and providing a better flow of content, I took this approach with APA citations and included a full reference list at the end.

I see the client this is for being an adult, but other than that I would want this to be a universal tool that could be translated to any language. 

I created a skeleton for gathering the information for goals one and two; nutrient name, a few key functions, and food sources. For goal three, I really like Harvard’s Healthy Eating Plate against MyPlate for a visual of how to combine food groups to have a balanced meal. I think having information of “what” and “where” regarding each nutrient, then culminating with applying “how” to build a plate is a really good approach for this CCIP for this client because of how much information there is on 10 micronutrients. For some reason superheroes came into my mind as a metaphor for explaining how these all work in synergy to support energy and cognition; the things this client is struggling with. There was a handout from the Virginia Department of Education that applied this metaphor, though in a different way than I am envisioning, but it also captures the flow of how this content might string together in a final piece which I appreciated. Additionally, The Academy of Nutrition and Dietetics also provided some guidance on how to educate on basic nutrition concepts, including micronutrients. They also have some cartoons/images that I like as inspiration.

Additionally, I think a final version of this CCIP could outline some example meals for optimal intake of these micronutrients.

I broke this storyboard into two parts. I outlined the functions, anatomical impacts post-operatively on absorption, and supplement recommendations in one part. In the other part drafted a visual to connect how the changes and recommendations are related to the anatomical shifts. It was interesting to see in my research on post-operative nutrition considerations how many hospitals and researchers agree on post-operative nutrition guidelines. I only noticed small variations in some total doses of supplements. All of my references are in a third, separate document in Padlet for review as desired. I used to work in a bariatric surgical ward and did a lot of nutrition support for patients where their nutritional status declined significantly post-operatively. I really liked getting to dive into this topic this week, and I think there’s a lot of creativity to be had in a finalized version of this CCIP.