Association Between Variation in Red Cell Size and Multiple Aging-Related Outcomes

Kyoung Min Kim, Li Yung Lui, Warren S. Browner, Jane A. Cauley, Kristine E. Ensrud, Deborah M. Kado, Eric S. Orwoll, John T. Schousboe, Steven R. Cummings

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


BACKGROUND: We tested whether greater variation in red blood cell size, measured by red cell distribution width (RDW), may predict aging-related degenerative conditions and therefore, serve as a marker of biological aging.

METHODS: Three thousand six hundred and thirty-five community-dwelling older men were enrolled in the prospective Osteoporotic Fractures in Men Study. RDW was categorized into 4 groups (≤13.0%, 13.1%-14.0%, 14.1%-15.0%, and ≥15.1%). Functional limitations, frailty, strength, physical performance, and cognitive function were measured at baseline and 7.4 years later. Falls were recorded in the year after baseline; hospitalizations were obtained for 2 years after baseline. Mortality was assessed during a mean of 8.3 years of follow-up.

RESULTS: Participants with greater variability in red cell size were weaker, walked more slowly, and had a worse cognitive function. They were more likely to have functional limitations (35.2% in the highest RDW category vs 16.0% in the lowest, p < .001) and frailty (30.3% vs 11.3%, p < .001). Those with greater variability in red cell size were more likely to develop new functional limitations and to become frail. The risk of having 2 or more falls was also greater (highest 19.2% vs lowest 10.3%, p < .001). The risk of hospitalization was higher in those with the highest variability (odds ratio [95% confidence interval], 1.8 [1.3-2.5]) compared with the lowest. Variability in red cell size was related to total and cause-specific mortality.

CONCLUSION: Greater variability in red cell size is associated with diverse aging-related outcomes, suggesting that it may have potential value as a marker for biological aging.

Original languageEnglish (US)
Pages (from-to)1288-1294
Number of pages7
JournalThe journals of gerontology. Series A, Biological sciences and medical sciences
Issue number7
StatePublished - Jun 14 2021

Bibliographical note

Publisher Copyright:
© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail:


  • Aging
  • Biomarker
  • Complete blood cell count
  • Red cell distribution width


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