1. Liebig’s Law of the
Minimum
Yield is proportional to the
amount of the most limiting
nutrient, whichever nutrient
it may be.

3. Nutrition Assessment, Counseling & Support
S
C
A
N
N N
A NACS
A
C C
S S
S
C
A
N
Establishing a Nutrition Standard of Care

4. GOAL: Improved health and quality of life
OBJECTIVES:
• Improve nutritional status
• Improve infant survival
• Reduce food insecurity
• Strengthen health systems
Economic
Nutrition care HIV-Free Survival strengthening, Health system
& support livelihoods & food strengthening
security
NACS: A platform for integrating nutrition into the continuum of care

5. NACS: A Life Cycle Approach
NACS

6. Linearizing the Life Cycle as a
Continuum of Care
Pregnancy Birth Infancy Childhood Adolescence Adulthood

7. C&T
ART & ARV
Prophylaxis
Tx of
Malnutrition
Maternal
Nutrition &
IYCF
Counseling
Photos: Wendy Hammond
Photo: Wendy
Hammond
Pregnancy Birth Infancy Childhood Adolescence Adulthood

8. ART & ARV
Prophylaxis
Peri-/Postnatal
Care
Maternal
Nutrition &
IYCF Counseling Photo: Wendy Hammond
Pregnancy Birth Infancy Childhood Adolescence Adulthood

9. Postnatal Care
Deworming
Micronutrients
IYCF/GMP
CMAM
Tracking/Follow-Up of
Mother-Infant Pairs
Photos: Save the Children Federation
Pregnancy Birth Infancy Childhood Adolescence Adulthood

10. Pediatric Care
Nutrition
Surveillance/GMP &
Referral
Micronutrients
CMAM
Photo of Plumpy’nut® from
Valid International; all others:
Save the Children Federation
Pregnancy Birth Infancy Childhood Adolescence Adulthood

11. Nutrition
Nutrition
Surveillance,
Surveillance,
Referral, Assessment
Referral, Assessment
& Counseling
& Counseling
Deworming
Micronutrients
Micronutrients
Tx of malnutrition
CMAM
Photo: LINKAGES Project
Pregnancy Birth Infancy Childhood Adolescence Adulthood

12. Why NACS??
• Links vulnerable to clinical services -- reciprocal impact
between health & nutrition -- most powerful nutrition
intervention for AIDS patients is ART
• Corrective  chronic nutrition mgmt -- continuum of care
• Link patients to support groups & community services
• Referrals for economic strengthening, livelihood & food
security (ES/L/FS) support
• Health system strengthening -- NACS for general
population, not just HIV-patients & families

13. NACS Hinges on Nutrition Assessment
1. Routine Comprehensive Assessment
• Anthropometry
• Biochemical
• Clinical
• Dietary
• Household Food security
2. Analyze/interpret data using evidence-based standards
3. Identify nutrition problems
4. Determine causes/contributing risk factors
5. Cluster signs/symptoms and defining characteristics
6. Determine an appropriate Nutrition Care Plan

14. Nutrition Counseling
1. Understanding of client preferences, constraints &
options
2. Nutrition Care Plans
3. Optimal diet
4. Dietary management of symptoms
5. Dietary management of drug side-effects
6. Adherence to medications & clinical visits
7. Chronic disease management
8. Exercise
9. Water, sanitation, and hygiene (WASH)
10. Referral to community services, including household
ES/L/FS support

15. Nutrition Support
Treatment of Prevention of Economic Water, Sanitation, &
Malnutrition Malnutrition Strengthening, Hygiene (WASH)
Livelihood & Food
Security Support
• Corrective • Routine Medical • Savings • Distribution of
Medical Care & Care & Tx • Microcredit POU water
Tx • Provision of MN • Income- treatment
• Food by Supplements generating products or
Prescription • Provision of activities vouchers
• Provision of MN Complementary • Household food • Latrine
Supplements Foods/Dietary production construction
Supplements • Food assistance

16. Enabling Environment
Policies, Strategies &
Supply Chain Management
SUN/ Guidelines Training
1000 Funding/Financing PEPFAR
Days Research/M&E
Community
Feed Mapping/Stre Demand
Title II
the ngthening
Future Referral Links &
Services
Tracking
Global NACS
Health
Initiative
Human Resources Quality Improvement

17. NUTRITION
SUPPORT
NUTRITION
COUNSELING
Exercise
IYCF/GMP
Maternal Nutrition
Nutrition NUTRITION Household
Care Plan ASSESSMENT food
Support
rations
Clinic Food by Prompt Anthropometry Groups Community
Prescription: treatment of Clinical
Therapeutic, Dietary Community Health Workers
infections
Supplementary & Biochemical Food
Complementary Adherence to security Economic
Foods medications Strengthening,
Livelihoods &
Dietary management Food Security
of symptoms, drug
side-effects and drug-
food interactions
WASH
Point-of-use water treatment
Micronutrient supplements
17