Low iron, calcium, manganese, and zinc concentrations have been reported, and the iron-to-copper ratio has been reported to be decreased. Studies reported that intracellular zinc in blood mononu-clear cells was approximately 47% lower than that of normal controls, and it is possible that this may play a role in thyroid dysfunction, immunodeficiency, retarded growth, and faulty DNA repair. Further research is required to determine if zinc supplements are beneficial and at what level. Supplementation with selenium aimed at increasing levels of the selenium-dependent enzyme glutathione peroxidase is reported to have led to a decrease in initially high blood mononuclear cell levels of copper, but it did not affect iron or zinc.

Vitamin and mineral levels have been held to reflect not just nutrient intake but also abnormal metabolism. Assessments of antioxidants and oxidation by-products are useful indicators of nutritional status in people with Down's syndrome. The overexpression of the superoxide dismutase system, the purine synthesis pathway, and cystathionine ^-synthase are thought to create extra demands for antioxidants and for folate, but despite gene dosage effects the many biochemical anomalies that have been reported in people with Down's syndrome show a great deal of individual variation.

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