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					The International Journal of Cuban Studies Volume 2 Issue 1 June 2009                              1




THE INTERNATIONAL JOURNAL OF CUBAN STUDIES
(Print) ISSN 1756-3461   (Online) ISSN 1756-347X                           www.cubastudiesjournal.org




Somatophysiological and nutritional characterization of the Cuban
centenarian population of Villa Clara province: reproductive
patterns and gender perspectives

Consuelo Prado Martinez, Esmir Camps Calzadilla, Mercedes Gamez
Fonseca, Mailin Borroto Castellano and Alberto Fernandez Seco.


Summary

Life expectancy has increased considerably in recent decades and with it the
need to understand the aging process. Cuba’s demographic indicators are similar
to those of the developed world with a 78.97 life expectancy at birth for women
and 75.13 for men. At the close of 2007, seniors made up 16.2% of the
population. This situation has led to the emergence of another phenomenon:
more individuals reaching 100 years of age. There were 1,488 Cuban
centenarians by the end of 2007. This investigation looks at the rarity of this
phenomenon with regards to gender, genetic predisposition and the influence of
lifestyle on longevity and continued good health. It forms part of the Cuban
Centenarians project sponsored by the Ministry of Public Health and the Council
of State, which highlights the fact that Cuba has the highest health index in Latin
America and the Caribbean, comparable to that of developed countries. One of
the project’s many objectives is to characterize centenarian populations from a
somatophysiological and nutritional point of view and then to determine the
behavior of the anthropometric, biochemical and nutritional indicators, in an
attempt to identify biological and socio-cultural determinants responsible for the
differences in longevity between men and women. Another goal is to contribute
information regarding methodologies for collecting data and designing a bio-
cultural study of aging.



Introduction

Aging is a genetically regulated physiological process that is continual and
progressive from birth to death in every living being. Longevity has been
considered a positive expression of the development of humanity. However,
there is no doubt that longevity presents great challenges to health and to
society, given that old age brings with it illness and debilitation. Longevity does
not always lead to more years enjoyed, but instead to more years in a debilitated
state. Advances in biomedical science and improvements in healthcare policies
have not only contributed to an increase in life expectancy, but also to a

Somatophysiological and nutritional characterization of the Cuban centenarian population of
Villa Clara province. Consuelo Prado Martinez, Esmir Camps Calzadilla, Mercedes Gamez
Fonseca, Mailin Borroto Castellano and Alberto Fernandez Seco
The International Journal of Cuban Studies Volume 2 Issue 1 June 2009                         2



reduction in the proportion of incapacitated elderly. Thus it is possible to suppose
that in the future, life expectancy will improve in terms of years and good health.
The growing elderly population represents a new biosocial situation in the history
of our species that requires a comprehensive understanding of the aging process
including variability under different environmental circumstances, gender specific
characteristics, genetic control of the process, and the influence of lifestyle on
healthful longevity.

Currently the proportion of individuals of advanced age in developed countries
(21%) is much higher than that of developing nations (8%). Overall life
expectancy gradually increased by 18 years between 1950 and 2005. However
despite that general trend, variability exists between and within regions. In
Europe, for example, Sweden boasts the highest expectancy for men (77.7)
while in Spain women live significantly longer (83.1). In most countries the
reduction in mortality has been more pronounced in women than in men. From a
generational perspective that means women are living longer and consequently
they constitute the majority of elderly in nearly all countries representing 55% of
the population over 60 and outnumbering men by some 70 million. Among those
over 80 the ratio becomes nearly 2:1, with women comprising 65% of this age
group. However, it is important to note that although women live longer, they
suffer more debilitation.

The effects of malnutrition on the degenerative process is a controversial topic
and a wide range of results can be found among references. Indeed, the affects
of malnutrition vary according to the population and even the setting and
environment in which the individual lives. For example, it is known that
individuals over 60 who are free living in their community experience a very
different decline than those who are institutionalized (Díaz et al 2005).
Understanding the effects of malnutrition would result in one of the most efficient
indicators for predicting mortality in a fairly short period of time. This justifies
the need, and the support for, studies designed to reveal the nutritional status of
older adults employing the necessary and appropriate resources that at the same
time allow findings to be extrapolated to the general populace (Onis et al 1996).
That knowledge would enhance intervention aimed at lessening the negative
impact of malnutrition and achieving healthy aging.

Through the lens of anthropology, somatic and functional evidence are objective
measurements that unfortunately are not always feasible. A questionnaire known
as the Mini Nutritional Assessment (MNA) is used for malnutrition assessment. In
older adults the MNA has revealed an apparent synchrony between low scores
and low values in anthropometric and biochemical characteristics. An association
between the MNA score and age has also been indicated (Guigoz et al 1996;
Vellas et al 2000). However those studies have involved individuals of less
advanced ages. Nutritional demands in centenarians would be different due to
lowered metabolism at the expense of reduced protein renewal and decreased
activity of many cellular groups (Perls et al 1998). Are these indicators equally
valid in a group that has exceeded the average life expectancy of all current
human populations? Moreover there are multiple biological and psychological
factors that could influence the balance of energetic demands, making
classification for each population necessary Kane (2000). Based on the above
Somatophysiological and nutritional characterization of the Cuban centenarian population of
Villa Clara province. Consuelo Prado Martinez, Esmir Camps Calzadilla, Mercedes Gamez
Fonseca, Mailin Borroto Castellano and Alberto Fernandez Seco
The International Journal of Cuban Studies Volume 2 Issue 1 June 2009                         3



and in an attempt to meet important basic objectives, this current work was
proposed as part of the Centenarians in Cuba study. Through objectivity of
somatic data we test the effectiveness of the MNA while contributing a
perspective of gender addressed in few prior studies (Kuezmarski 1989;
Perissinotto et al 2002).


Population and Methods

This transversal descriptive study included all individuals over the age of 100
present in the Cuban province of Villa Clara. In addition to the pertinent
procedures described below, informed consent from subjects and their families
were obtained prior to their inclusion in the study.

To identify the population for our study, we relied on two credible sources: the
Ministry of Public Health Registry (every health district in Cuba maintains a
registry of centenarians) and the 2002 Census, from which we identified all those
who were 98 or more years old at that time. Information from the two sources
was complied creating one comprehensive, master list. Social workers of each
provincial health district updated this master list by visiting possible centenarians
and confirming their presence and residence. The new list was validated by a
group of independent experts from the National Statistics Office (known in
Spanish as the ONE). Our final sample of 134 verified centenarians included all
individuals 100 or more years of age in the province.

The interviews took place in the home or residence of each centenarian using a
questionnaire with 11 sections covering various aspects of life. The centenarians
as well as their caretakers were interviewed depending on the mental state of
the study subject. In all cases the interview was carried out by qualified
personnel: nurses or previously trained social or geriatric aides.

The anthropometric measurements were obtained according to the International
Biological Program (IBP) and were only taken by physiology specialists belonging
to the Institute of Basic and Pre-clinical Sciences (ICBP) at Victoria de Girón, who
traveled to the area to visit each subject. This same team performed the
functional tests. Blood samples were obtained during the same visit by local
technical personnel specialized in clinical laboratory analysis.
For the purposes of this study we examined the data from section A (general
information, living conditions, history of centenarian and family) and section K
(nutrition, anthropometric and functional measurements).

We used the MNA to evaluate nutrition, which includes questions about eating
habits, lifestyle, illnesses, and self-view of nutritional state. Results are
expressed as a score with the following scale: <17 = malnourished; 17-23.5 = at
risk of malnutrition; >23.5 = normal.

Although the recommendations of the IBP were followed in the anthropometric
measurements, height was estimated by plugging a direct measurement of heel-
to-knee height into the following equations developed for the Cuban population
by Díaz (2003).
Somatophysiological and nutritional characterization of the Cuban centenarian population of
Villa Clara province. Consuelo Prado Martinez, Esmir Camps Calzadilla, Mercedes Gamez
Fonseca, Mailin Borroto Castellano and Alberto Fernandez Seco
The International Journal of Cuban Studies Volume 2 Issue 1 June 2009                         4




Male height       = 78.5711 - 0.1778 x Age + 1.8758 x heel-to-knee height

Female height = 88.9069 - 0.1861 x Age + 1.5779 x heel-to-knee height

In addition, we recorded mid-arm and calf circumferences and determined body
weight using an upright portable SEKA brand scale.

The BMI was derived using the following formula (with the height being
calculated from heel-to-knee height): BMI = Weight (Kg)/Height (m2). We
followed the FAO/WHO classifications for malnutrition risk in adults (CED =
chronic energy deficiency).

BMI <16 (CED III), BMI 16-16.9 (CED II), BMI 17-18.4 (CED I), BMI 18.5-24.9
(acceptable), BMI 25-29.9 (overweight), BMI 30.0-39.9 (obese), BMI ≥40.0
(extreme obesity).

Grip strength was measured while standing with hand in line with forearm, elbow
extended, arm lateral to the body and without using the body for support. The
best result out of two tries was recorded for each hand.

Walking speed was measured by the time required for the subject to cover a
distance of 4.5 meters (≈10 steps) at their normal pace. Also noted was the
number of steps required to complete the set distance and whether or not the
foot was lifted completely off or dragged along the floor during steps.

The subject’s ability to stand up out of a chair without assistance was
characterized in the following way: a) unable without help b) able but with
several attempts c) able on first try.

The personnel who performed the interviews were also trained to detect the
presence of physical or mental abuse perpetrated against the subject or
situations of abandonment by the nuclear family. The compiled information was
coded and entered into a Microsoft Access database excluding personal
identifiers.


Results

There was a total of 134 individuals of 100 or more years of age living in the
province of Villa Clara, Cuba. Of these 82 were female (61.19%) and 52 were
male (38.81%). The maximum age recorded for both genders was 106. Above
102 years, the sample size lessened by 50%.

It is worth emphasizing that females predominate in this population, as they do
among centenarians of Havana and similar to what has been found by other
studies. Until now, however, intrinsic biological characteristics linked to the
female reproductive cycle have not been analyzed in female centenarians.



Somatophysiological and nutritional characterization of the Cuban centenarian population of
Villa Clara province. Consuelo Prado Martinez, Esmir Camps Calzadilla, Mercedes Gamez
Fonseca, Mailin Borroto Castellano and Alberto Fernandez Seco
The International Journal of Cuban Studies Volume 2 Issue 1 June 2009                         5



The first event we considered was the age at onset of menstruation (menarche).
This information was obtained using the retrospective method, reconfirmed on a
second occasion, and corrected according to Tanner (1966). The age of last
menstruation (menopause) was obtained and corrected in the same way but only
natural menopauses were included in the calculations. Table 1 contains average
age at menarche and menopause and the average number of post-menopausal
years for the study group. In addition, the average length of reproductive years
for the study group and the general population are shown along with the average
reproductively active period for the study group. In the last case, women without
offspring were excluded.

 Variable               X ± SD                 Variable                  X ± SD
 Menarche Age           13.57 ± 1.83           Reproductive Years        35.43 ± 3.28
                                               Centenarians
 Menopause Age 50.36 ± 2.51                    Reproductive Years        32.0
                                               General Population
 Post-                  52.19 ± 2.65           Reproductively            9.37 ± 4.1
 Menopausal                                    Active Years
 Years                                         Centenarians

Table 1. Characteristics of female reproductive cycle of centenarians living in Villa Clara,
Cuba.


Maternity is another aspect of great interest given the current controversy over
its positive affects on the functional state of adult women. In this study 13.41%
of female centenarians had no offspring. When unmarried women (4.88%) were
excluded, that number dropped to 8.53%. The youngest age at time of maternity
was 16 and the oldest was 48, with maternity before the age of 20 accounting
for 11.27%. The most common age at first maternity was 24. The average age
at first maternity was relatively high, 27.21 ± 6.44, which calls attention to first
pregnancies occurring later than normal for that era, that is to say, after the age
of                                                                              33.

Nearly 13% had their last child after the age of 35 (12.69 %). The number of
offspring per centenarian was 4.44 ± 3.47. The analysis of the non-reproductive
years of these women puts in question its primordial role in the female lifecycle.
This population of women experienced 13 pre-menarche and 53 postmenopausal
years, 66 years absent of the biological capacity to reproduce.

A comparison of longevity between ethnic groups has seldom been attempted
due to the difficulty in finding comparable methods and similar qualities of life. In
terms of centenarians, data is partial and originates from different studies and
contexts. Shown here are some preliminary results regarding survival past 100
years calculated from one population sharing a common context. Table 2 is a
demographic summary of Villa Clara province from the 2005 ONE report,
coinciding with the commencement of the centenarian study.




Somatophysiological and nutritional characterization of the Cuban centenarian population of
Villa Clara province. Consuelo Prado Martinez, Esmir Camps Calzadilla, Mercedes Gamez
Fonseca, Mailin Borroto Castellano and Alberto Fernandez Seco
The International Journal of Cuban Studies Volume 2 Issue 1 June 2009                         6




 Population   White        Black                           Mixed               Total
 Total        675.855      54.526(6.3%)                    83.354              813.735
              (83%)                                        (10.3%)
 Centenarians 102 (78.5 %) 12 (9.2 %)                      15 (12.3 %)         129*

Table 2. Characterization of general and centenarian populations with regard to skin
color. *Categories with low representation in either the study or general population were
excluded

Although whites comprised the largest contingent of centenarians, in relation to
the general population of Villa Clara whites are under represented (83% in the
general population vs. 78.5% of centenarians), while blacks are over represented
(6.3% in the general population vs. 9.2% of centenarians) and those of mixed
heritage occupy an intermediate position (10.3% in the general population vs.
12.3% of centenarians).

Due to the scarcity of existing data, there is enormous interest in somatic
evaluation within a province that has a strong agricultural tradition and rural
living conditions. Who are these super survivors? Table 3 summarizes the
anthropometric characteristics of the entire study group and of each sex.


 Variable                      Total
                       Sample size                             Males        Females
 Weight (kg)                   46.00
                       95 (42 f, 53 m)    ±                    50.32      ± 42.58 ± 8.35
                               10.77                           12.06
 Heel-to-Knee  126 (50 f, 76 47.75 ± 6.04                      49.73 ± 6.90 46.45 ± 4.96
 Height (cm)   m)
 Height*(cm)   126 (50 f, 76 147.5 1 ±                         153.82     ±       143.36     ±
               m)              11.44                           13.11              7.86
 BMI           95 (42 f, 53 m) 21.13 ± 5.82                    21.87 ± 7.41       20.54 ± 4.10
 Upper-Arm     125 (49 f, 76 22.48 ± 4.97                      23.36 ± 4.41       21.91 ± 5.25
 Circumference m)
 (cm)
 Calf          125 (48 f, 77 27.46 ± 4.05                      28.32 ± 4.09       26.93 ± 3.96
 Circumference m)
 (cm)

Table 3. Anthropometric characteristics of the centenarians living in Villa Clara, Cuba by
total sample and by sex. *Calculated from heel-to-knee height (M. E. Díaz).



The usefulness of anthropometric markers is unquestionable (Marrodán et al,
(1995; Dadan, 1999). They objectively reflect the physical state of individuals
and populations. The difficulty in this study is that they indicate conditions
scarcely referenced to date. Centenarians are of small stature and although they
are usually thin, they have acceptable BMI values.




Somatophysiological and nutritional characterization of the Cuban centenarian population of
Villa Clara province. Consuelo Prado Martinez, Esmir Camps Calzadilla, Mercedes Gamez
Fonseca, Mailin Borroto Castellano and Alberto Fernandez Seco
The International Journal of Cuban Studies Volume 2 Issue 1 June 2009                         7



In our study all values were inferior to average values estimated for the general
adult Cuban population. The height differences between sexes found in the
general population was maintained and was significant (p< 0.05) within the
study group with the difference exceeding 10.5 cm. It is estimated that height
decreases 1 cm per decade after the age of 60 and even more acutely after 80.
However, recall that an indirect method was used to calculate height, thereby
somewhat minimizing the deterioration and reduction caused by spinal curvature
(lordosis or kyphosis).

Regarding weight, our study results followed the pattern of decline after 65 years
of age described in other senior populations (Capo, 2002). In elderly populations,
weight as an indicator of age lacks importance because it appears to be affected
by a diverse variety of genetic and social factors that are not exclusively tied to
age. However in the case of centenarians, a decrease in weight is observed with
advanced years. According to the results obtained from this study there is a
marked difference between the sexes: males averaged 10 kilograms heavier than
females.

The BMI is a derived variable widely used in populational and ontogenetic
contexts. An increase in BMI among older adults of both sexes is later followed
by a progressive decrease (Masaka et al 1997; Valle et al 2007). Within this
general trend however, there is inconsistency between the sexes. While some
studies show higher BMI for males, others register higher values for females
(Alemán et al 1999; Perissinotto et al 2002). In the Villa Clara sample no
significant differences were found between male and female averages at the
population level. Although the average BMI of females was inferior, values varied
less across ages in females than in males, whose decline was more pronounced.
These results contrast with the centenarian population of Havana, where the BMI
of females is higher than that of males. Even though there are no classifications
specifically for centenarians, the average values found among 56.38% of
individuals (20.54 kg/ m² for females and 21.87 kg/ m² for males) were within
acceptable limits; 12.27% fit into the overweight category; and a high percent,
30.85%, fit into the different categories of malnutrition (FAO/WHO, 1994).

The acceptable range included a slightly higher percent of females, but the
gender difference was not statistically significant. The relatively unstudied
physiological state of centenarians compels us to reconsider the validity of the
current classification cut-off points given that their condition could be due to a
notable metabolic change and a new state of somatic stability.

Body measurements are good indicators of muscle mass. The upper-arm and calf
circumference, in addition to being easy to measure, are valid even for those of
advanced age or the bedridden. Arm circumference values of both sexes were
lower than those of the adult Cuban population (Berdasco et al 2002). Values in
females were higher than in males (23.45 cm and 22.65 cm respectively), but
the difference was not statistically significant. If these values are compared to
the Havana city centenarian population, marked differences are found: arm
circumference in the province was 1.40 cm higher overall, while among males
only 0.27 cm higher. There is no calf circumference standard for Cuban adults.

Somatophysiological and nutritional characterization of the Cuban centenarian population of
Villa Clara province. Consuelo Prado Martinez, Esmir Camps Calzadilla, Mercedes Gamez
Fonseca, Mailin Borroto Castellano and Alberto Fernandez Seco
The International Journal of Cuban Studies Volume 2 Issue 1 June 2009                         8



Among the elderly studied in Villa Clara the average values were 26.60 cm. for
females and 27.82 cm. for males. This parameter is one of the most sensitive to
muscular tissue loss, even more so than the arm circumference, especially when
there is a decrease in physical activity (Herrera 2003). In both sexes the values
in the province were lower than those found in Havana city, being more
pronounced in males than in females, which were more uniform within and
between populations.

The question that follows is how functional can one be in this somatic condition.
It is known that older adults value the ability to remain active rather than the
possibility to just continue living. Therefore, functional condition must be
analyzed in order to evaluate the quality of life and health of these individuals.
There are two fundamental reasons. First functionality is a factor in loss of
independence, institutionalization and consumption of medical and social
resources: Fragile Elderly. Second, functional deterioration is linked to other
pathologies. Table 4 summarizes the functional capacities in percentages found
in Villa Clara by total sample and by sex. Capacity was measured by
dynamometric strength, speed of unassisted walking and ability to stand up
independently.

               Females      Males        Total
Strength       56.9         82.69        66.41
Walking        39.02        50           43.28
Standing       59.75        75           65.67

Table 4. Percent of centenarian males and females capable of completing test.

More than half of the centenarians showed very acceptable levels of functionality
as reflected by their dynamometric strength and capacity to stand up and walk
without any assistance. They were fully capable of performing these activities.
Functional ability was higher in males than females. So while more females reach
older ages, they do so in poorer condition. The question is: does this indicate
that females have a less demanding survival mechanism than males or to the
contrary, do the physiological aspects of the female life cycle: pregnancies,
childbirths, hormonal changes, menopause, etc. make them more susceptible to
declining and faltering health in advanced years.

If we analyze the somatic condition by relating arm circumference to
dynamometric strength and calf circumference to the ability to walk, the results
are conclusive in both sexes. Those who were capable of performing the
functional tests showed significantly higher values in these parameters (p <0.05)
than those who could not perform them. The average calf measurement of the
former was 29.07 ± 3.8; the latter was 26.16 ± 5.28. Arm measurements were
23.19 ± 4.71 and 20.84 ± 5.23 respectively. For the overall adult population
31cm is accepted. For the centenarian study group this value was lower although
the value for males was close to that figure.




Somatophysiological and nutritional characterization of the Cuban centenarian population of
Villa Clara province. Consuelo Prado Martinez, Esmir Camps Calzadilla, Mercedes Gamez
Fonseca, Mailin Borroto Castellano and Alberto Fernandez Seco
The International Journal of Cuban Studies Volume 2 Issue 1 June 2009                         9



As previously noted, the BMI categories are questionable when it comes to
defining conditions of malnutrition. In light of the satisfactory functionality
observed, a nutritional survey was carried out based on the Mini Nutritional
Assessment (MNA), a tool used for early detection of nutritional disorders in
older adults. Its inclusion in the protocol of overall geriatric evaluation has been
suggested. In the case of Villa Clara 94 subjects were able to reliably complete
the                 test                (see                 Table                5).


 MNA                   Total                   Males                    Females
 Malnourished          29          30.85       18          42.86        11      21.15 %
                                   %                       %
 Risk of               52          55.32       19          45.24        33        63.46 %
 Malnutrition                      %                       %
 Well                  13          13.83       5           11.90        8         15.38 %
 Nourished                         %                       %
 Total                 94          100 %       42          100 %        52        100 %

Table 5. Nutritional survey based on the MNA: absolute values and percentages for both
sexes.

The MNA values show even higher levels of malnutrition risk than the BMI. If
both methods are combined, 36.54% of centenarians are in the acceptable
range. The tool therefore needs to be revised to fit the context of the phase of
life beyond 100 years.


Conclusions

The population of Villa Clara province is the oldest in Cuba with 19.97% over the
age of 60. Of that group, there is one centenarian per 6019 inhabitants, while in
the rest of the island the figure is 1 per 8000 inhabitants. In addition, the longer
survival of females has been confirmed coinciding with findings in Havana city. In
this study, in relation to ethnicity, blacks are more likely to live past 100 years.
Next likely are those of mixed heritage while the least likely are Caucasians when
compared to each group’s relative representation in the province’s general
population.

Considering the female reproductive cycle, the age of menarche of the
centenarians compared to current references and those of past decades shows a
secular change toward younger maturation.         Of special note, the age of
menopause among centenarians of Villa Clara is slightly higher than estimates
for the current Cuban population suggesting that this feature of aging is delayed.
However, this should be confirmed by future regional studies.

When the MNA alone is used, the evaluation of nutritional state is at odds with
other nutritional and functional evaluation methods and with the survival of the
subjects (only a sixth of the centenarians would fall in the acceptable range).
This suggests that the test is is not appropriate for this type of population.


Somatophysiological and nutritional characterization of the Cuban centenarian population of
Villa Clara province. Consuelo Prado Martinez, Esmir Camps Calzadilla, Mercedes Gamez
Fonseca, Mailin Borroto Castellano and Alberto Fernandez Seco
The International Journal of Cuban Studies Volume 2 Issue 1 June 2009                         10



It has been demonstrated that physical performance is directly related to
predictors of nutritional state. However with respect to values obtained for males
and females, preservation and functionality is lower for females. In all cases
women’s somatic variability and nutritional state were more stable over the
years and after reaching 100 years, which would indicate that in advanced age
there is continuing greater female ecostability.


Consuelo Prado Martinez, Departamento de Biología, Facultad de Ciencias,
Universidad Autónoma de Madrid, España. Email: consuelo.prado@uam.es
Esmir Camps Calzadilla, Instituto de Ciencias Basicas y Pre-clínicas (ICBP)
Victoria de Girón, Instituto Superior de Ciencias Médicas, La Habana, Cuba.
Mercedes Gamez Fonseca, ICBP Victoria de Girón, Instituto Superior de
Ciencias Médicas, La Habana, Cuba.
Mailin Borroto Castellano, ICBP Victoria de Girón, Instituto Superior de
Ciencias Médicas, La Habana, Cuba.
Alberto Fernandez Seco, Centro Iberolatinoamericano Para La Tercera Edad
(CITED), La Habana, Cuba.




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Somatophysiological and nutritional characterization of the Cuban centenarian population of
Villa Clara province. Consuelo Prado Martinez, Esmir Camps Calzadilla, Mercedes Gamez
Fonseca, Mailin Borroto Castellano and Alberto Fernandez Seco
The International Journal of Cuban Studies Volume 2 Issue 1 June 2009                         11



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Somatophysiological and nutritional characterization of the Cuban centenarian population of
Villa Clara province. Consuelo Prado Martinez, Esmir Camps Calzadilla, Mercedes Gamez
Fonseca, Mailin Borroto Castellano and Alberto Fernandez Seco
The International Journal of Cuban Studies Volume 2 Issue 1 June 2009                         12




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                    IJCS Volume 2 Issue 1 June 2009

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Somatophysiological and nutritional characterization of the Cuban centenarian population of
Villa Clara province. Consuelo Prado Martinez, Esmir Camps Calzadilla, Mercedes Gamez
Fonseca, Mailin Borroto Castellano and Alberto Fernandez Seco

				
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