Red cell distribution width, inflammatory markers and cardiorespiratory fitness: results from the National Health and Nutrition Examination Survey

Indian Heart J. 2012 Jul-Aug;64(4):380-7. doi: 10.1016/j.ihj.2012.06.006. Epub 2012 Jun 21.


Aims: Cardiorespiratory fitness is an important predictor of cardiovascular morbidity and mortality. Both red cell distribution width (RDW) and inflammatory markers like C-reactive protein (CRP) have been shown to predict adverse outcomes in patients with heart disease.

Methods: We utilized pooled data from NHANES 1999-2004 to assess cardiorespiratory fitness in healthy adults 12-49 years old using submaximal exercise. The primary outcome was the estimated maximal oxygen uptake (VO2max). Low fitness was defined as VO2max < 20th percentile of age- and gender-based reference category.

Results: In our study, we estimated 21.2% of individuals had low fitness. Elevated RDW (>13%) was encountered in 20.4% subjects with low fitness as compared to 14.0% subjects in the control group (p < 0.001). Similarly, elevated CRP (>0.5 mg/dL) was found among 17.4% subjects with low fitness as compared to 12.4% subjects in the control group (p < 0.001). Adjusted analysis demonstrated a dose-response relationship between low cardiorespiratory fitness and increasing RDW or CRP.

Conclusion: In a large representative database of general US population, we observed a significant association between elevated RDW and elevated CRP with low cardiorespiratory fitness.

MeSH terms

  • Adolescent
  • Adult
  • C-Reactive Protein / analysis*
  • Child
  • Erythrocyte Indices*
  • Exercise Tolerance / physiology*
  • Health Status*
  • Heart Diseases / epidemiology*
  • Humans
  • Middle Aged
  • Nutrition Surveys
  • Odds Ratio
  • Oxygen Consumption
  • Respiratory Tract Diseases / epidemiology*
  • United States / epidemiology
  • Young Adult


  • C-Reactive Protein