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


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

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural


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