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Linda S. Potential for catch-up growth among stunted children is thought to be limited after age 2 y, particularly when they remain in poor environments. The mean increase in HAZ among those with such improvements was 1. The likelihood that children stunted at age 2 y would no longer be stunted at 8. Low birth weight, which Filipino guys tumblr associated with more severe stunting in the first 2 y of life, ificantly reduced likelihood of catch-up growth in later childhood.

Similar factors predicted the improvement in linear growth from 8. These suggest that there is a large potential for catch-up growth in children into the preadolescent years. Linear-growth retardation is a continuing health problem among children living in poverty in developing countries.

It is generally well accepted that most growth retardation occurs during the first 2 y of life, associated primarily with high rates of infection and inadequate nutrition related to poor weaning practices and poor dietary quality.

After 2—3 y of age, linear-growth rates of poor children are more similar to those observed in well-nourished children. Thus, deficits in adult height are attributed primarily to linear-growth retardation in infancy and early childhood Martorell and Habicht There is a lack of a consensus about the extent to which catch-up growth in later childhood and adolescence reduces the height deficit incurred in early childhood.

The biological potential for catch-up growth is well illustrated in studies that evaluate response to clinical intervention with supplementary feeding, treatment of illness or hormone therapy Golden Tanner advanced the general hypothesis that when undernourished children are exposed to better environments and good nutrition, the likelihood of catch-up is greater, with the degree of recovery depending on the severity of growth retardation and the timing of exposures.

However, the degree to which catch-up occurs in the absence of medical or nutrition intervention is less well documented. Martorell et al. They concluded Filipino guys tumblr when children remain in the same poor environment, the growth deficits developed in early childhood persist into adulthood, with little catch-up growth. Relatively little is known about the potential for catch-up growth during adolescence.

Conclusions about whether, how, and when catch-up occurs are based on limited evidence. First, relatively few longitudinal studies followed children from birth to late childhood or adulthood. Second, in the longitudinal studies that have been done, there are limited observation points with long gaps between measurements, so that changes in the environment and other factors that influence growth are not well documented. Third, epidemiologic studies of catch-up growth tend to compare groups of children or adults by their initial level of stunting e.

These studies tend to show substantial tracking of stature, with groups who were short as young children remaining short as older children or adults. However, with their focus on central tendencies of the groups, they fail to identify individual children who exhibit catch-up growth, and thus cannot contribute substantially to our understanding of the circumstances under which catch-up occurs. In this paper, we present evidence of catch-up growth based on a longitudinal ecological study of a cohort of Filipino children from Metro Cebu. Filipino guys tumblr focus on growth from age 2 to 12 y, with an intermediate measurement taken at age 8.

We model the overall determinants of height increments, identify children who exhibit catch-up growth, and identify factors associated with recovery from stunting. The study has a of important strengths. Third, we have detailed, repeated measures of socioeconomic and ecological conditions in each household, as well as dietary intake. Finally, by identifying individual children who recover from stunting, we can report the incidence of catch-up growth and, using multivariate methods, report determinants of recovery from stunting.

This is an ongoing survey in Metro Cebu, the second-largest metropolitan area in The Philippines. Metro Cebu encompasses urban and rural communities within and surrounding Cebu City. The most rapidly growing area of The Philippines, Metro Cebu is characterized by substantial economic development overall, but a high level of income disparity within the population.

From all of the barangays local administrative units of Metro Cebu, 17 rural and 16 urban barangays were randomly selected for the study. All pregnant women in these communities who gave birth in a 1-y period from to were asked to participate in the CLHNS.

Home visits were made to collect data during the last trimester of pregnancy, immediately after birth, then bimonthly for 2 y. Follow-up surveys were conducted in —92 and —95 when the children were, on average, ages 8. Infant recumbent length and weight were measured through 24 mo according to standard techniques, and interobserver reliability was routinely assessed. Height, weight and triceps and subscapular skinfold thicknesses were measured during the follow-up surveys.

Gestational age was determined from the date of the mother's last menstrual period. When there were pregnancy complications, an uncertain last menstrual period date, or when the infant weighed less than g at birth, the Ballard method was used to clinically assess gestational age Ballard et al. Preterm infants were those who completed less than 37 wks gestation. Detailed in-home interviews with mothers or caretakers, and community surveys with key informants, provided extensive information to characterize family socioeconomic status, demographics, and environment.

Dietary intake of mothers, infants, and children was assessed using h dietary recalls or quantitative food frequency questionnaires. The present analysis has a focus on three time points: ages 2, 8. In papers AdairAdair et al. The present analysis begins with 2-y-old children because this is the age by which most linear growth retardation is thought to occur.

The two intervals from age 2—8. First, patterns of growth and prevalence of catch-up during each of the two intervals are described, as are characteristics of children who exhibit catch-up growth vs. Multivariate linear and logistic regression models are used to identify factors ificantly associated with growth increments and catch-up growth. The analysis sample includes 2, children with complete data from the birth, 24 mo and two follow-up surveys. Losses to follow-up occurred because of death and migration from the metro Cebu area.

Exclusion from the analysis sample occurred because of missing data at one or more time points. As expected, the children lost to follow-up because of death differed ificantly from the surviving cohort: they were more likely to be from the poorest households, and to weigh less than 2, g at birth. However, children lost to follow-up after 12 mo or who had missing data did not differ ificantly in weight or length at 12 mo from those included in Filipino guys tumblr sample.

Characteristics of the sample are shown in Table 1. HAZ-scores for the full sample are presented in Figure 1. Mean height-for-age Z-scores of Cebu Longitudinal Health and Nutrition Survey sample males and female children from age 2 to 12 y. Data from the survey are cross-sectional by age, but linked with earlier longitudinal data for each. Characteristics of female and male Cebu Longitudinal Health and Nutrition Survey sample children, — Values represent mean of energy intake from nonbreast milk sources at ages 20, 22 and 24 mo, when on average, The assumption is that accelerated growth will return the individual to his or her genetically determined growth trajectory Ashworth and Milward However, sometimes catch-up is used to refer to complete recovery or Filipino guys tumblr of growth to normal levels.

In other cases, catch-up is considered to be an acceleration in growth rates which may or may not result in stature within normal limits for age and Filipino guys tumblr. For the present analysis, we define catch-up growth with and without reference to an external Filipino guys tumblr. Use of a variable representing a change in Z-score may be problematic because a Z-score has a different meaning at different ages Tanner Z-scores among older children may misclassify those whose pre-adolescent and early adolescent growth pattern differs from the WHO reference population.

Of concern for the present study is the likelihood of later sexual maturation relative to the reference population, and thus apparent inflation of the magnitude of growth retardation relative to the reference.

To avoid the use of an external reference, we also assess height increments in the two age intervals 2 to 8. The increment from age 2 to 8. Finally, we regress height at time t on height at time t-1, sex, and duration of the interval from t-1 to t, and calculate residuals. This method identifies children with greater than expected growth, irrespective of their starting length Esrey et al.

Covariates were specified as continuous variables in linear regression models. For ease of interpretation of relative risk ratios from logistic regression analysis, covariates were defined as categorical variables described below. Mother's height partially s for genetic growth potential. However, mothers in developing countries may not have reached their genetic potential for growth because of undernutrition and infection during their own childhood. Tall mothers were those with a height greater than Infants were considered long at birth if their recumbent length was above the 75 th percentile of the Filipino reference Florentino et al.

Child age is relevant only for the analysis of the 8—12 y time period. Girls were asked during the survey whether and when they had begun menstrual periods. For the logistic regression analyses, birth weight and gestational age were represented by a set of dichotomous variables representing low birth weight LBW -preterm, LBW-full term, and normal birth weight-preterm infants, with normal birth weight-full term infants as the reference category.

In the length increment models, birth weight was entered as a continuous variable. Socioeconomic status is represented by total household income at each survey; ownership of selected assets television, refrigerator, air conditioner, any motor vehicle ; presence of electricity and piped water; house construction light weight, traditional materials such as nipa palm vs.

We focus on level of the indicator at the beginning of each interval, as well as change in each indicator over the study intervals. Daily energy intake was calculated from h dietary recalls during the surveys from birth to 2 y and at age 11—12 y. During the —92 survey, intake was assessed using a quantitative food frequency questionnaire, with items derived from a list based on h food recalls from sample women. While these two methods are not directly comparable, they are useful for ranking individual's intakes. Dichotomous variables represented an increase in energy intake at or above the sample 75th percentile, or below the 25th percentile during the relevant interval.

We use several different multivariate analysis methods, depending on the form of the dependent variable. Data were analyzed using Stata Release 5 StataCorp Logistic regression is used to estimate the likelihood of recovery from stunting at time t among those who were stunted at time t-1, and to differentiate those with greater than expected growth from those with average or less than expected growth.

The analysis sample for the recovery from stunting model includes Filipino guys tumblr children who were stunted at age 2 y. Ordinary least squares linear regression is used to model height increments in the full sample, irrespective of stunting status at age 2 y. In all of these models, the dependent variable represents a change from one age to the next. First difference models have the advantage of controlling for the potential bias related to unobserved heterogeneity.

HAZ-scores of sample children at ages 2—12 y are shown in Figure 1. The data are stratified by age in half-year intervals to show the cross-sectional differences in height by age. There were no ificant differences in earlier height measures among children measured at different ages in — The lower HAZ scores of older girls most likely represent delayed maturity in the Filipinas relative to the U.

The prevalence of stunting in Cebu children is quite high when judged relative to the WHO reference. Using the Filipino national reference data and suggested cutoff of length below the 5 th percentile Florentino et al. Of the 1, children stunted at 2 y of age, Of those who recovered from stunting by age 8.

The mean change in HAZ from age 2 to 8. Only seven of these children had a change in HAZ of less than 0. Of the who recovered by age 8. All of the children in the recovery group had a height at age 8. Of the children stunted at age 8. Of the children with late recovery, Recovery from stunting is strongly associated with severity and timing of stunting. Table 2 defines groups of children by when during the first 2 y they first became stunted, then shows the mean HAZ Filipino guys tumblr each group at subsequent ages, and the percentage who recovered from stunting by age 8.

The children with the most severe stunting at 2 y were those who were stunted early in infancy. In turn, those with early stunting were also more likely to have been LBW infants see Adair and Guilkey for further discussion of the determinants of stunting in the first 2 y. While LBW occurred in only 2.

Overall, LBW infants were 3. Children with early, severe stunting had much lower rates of recovery from stunting by age 8. LBW, low birth weight. Filipino guys tumblr likelihood of recovery from stunting in the sample of 1, children who were stunted at age 2 was estimated using logistic regression.

are presented in Tables 3 and 4. Initial models included independent variables representing the change in risk factors from one time period to the next income, assets, housing quality, sanitary conditions, water and electricity, younger siblings born in the interval, energy intake as well as constant maternal factors height, parity at birth of the index child, educationand child characteristics birth weight and length, preterm status, sex, maturity for girls only.

In examining the effects of parity, it was apparent that most of the difference in growth related to first vs. Thus, a dummy variable indicating that the child was firstborn was included in the models. Determinants of the likelihood of recovery from stunting between 2 and 8. Variables which had no ificant effect on recovery from stunting: mother's education, change in household income, change in housing quality, acquisition of electricity and piped water.

Birth length greater than the 75 th percentile of the Filipino National Reference Florentino et al. Lowest quartile of increase in dietary energy intake from age 2 y to 8. Determinants of the likelihood of recovery from stunting from age 8. Variables which had no ificant effect on recovery from stunting: mother's height, birth weight, preterm status, change in household assets, change in housing quality, change in cleanliness around the house, change in energy intake or percentage calories from fat.

Birth length above the 75 th percentile of the Filipino National Reference Florentino et al. CI, confidence interval.

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