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Many symptoms of children and adults with DS are a consequence of excessive synthesis of multiple gene products, including an increase in the intracellular activity of Cu-Zn SOD due to overexpression of genes present on chromosome 21

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Several trials and updated analyses indicate improvements in fasting insulin, HOMA-IR, BMI/waist indices, and lipid parameters, particularly among women with obesity or IR and low baseline 25(OH)D, whereas pooled estimates from other RCTs fail to show consistent effects on fasting glucose or HOMA-IR, likely reflecting underpowered studies and short follow-up (118)

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