Association Between Serum 25-Hydroxyvitamin D Levels and Gross Motor Development in Children With Down Syndrome: An Analytical Cross-Sectional Study
Abstract
Background. Down syndrome (DS) is associated with delayed gross motor development, and vitamin D deficiency is frequently reported in this population. However, evidence regarding the relationship between vitamin D status and motor development in children with DS is limited.
Aim. To examine the association between serum 25-hydroxyvitamin D [25(OH)D] levels and gross motor development in children with DS.
Methods. This analytical cross-sectional study included 33 children with DS (13 females and 20 males) aged 1.00–6.56 years (mean age 2.53 ± 1.06 years). Gross motor development was assessed using the Basic Motor Skills (BMS) Test. Serum 25(OH)D concentrations were measured using electrochemiluminescence on a Cobas® e 411 analyser (Roche Diagnostics). Vitamin D status was categorised as deficient (<20 ng/mL), insufficient (20–29 ng/mL), or sufficient (≥30 ng/mL). Associations between vitamin D levels and gross motor milestones were evaluated using Spearman’s rank correlation and group comparisons.
Results. Vitamin D deficiency was observed in 36.4% of the participants, 12.1% had insufficient vitamin D levels, and 51.5% had sufficient vitamin D levels. No statistically significant correlations were found between serum 25(OH)D levels and any gross motor milestone (r range −0.172 to 0.292; all p > 0.05). The strongest correlation was observed for adopting a sitting position (r = 0.292), but it was not statistically significant (p = 0.099).
Conclusions. Vitamin D deficiency appears to be common in children with DS, while no significant association was observed between serum 25(OH)D levels and gross motor development in this sample. These findings highlight the need for larger, longitudinal studies to further clarify this relationship.
Keywords: Down syndrome; 25-hydroxyvitamin D; vitamin D deficiency; gross motor development; children
References
Antonarakis, S. E., Skotko, B. G., Rafii, M. S., Strydom, A., Pape, S. E., Bianchi, D. W., Sherman, S. L., & Reeves, R. H. (2020). Down syndrome. Nature Reviews Disease Primers, 6, 9. https://doi.org/10.1038/s41572-019-0143-7
Arizmendi, K. A. F., Tapia, Y. Y. G., Velazquez, F. J. M., Robledo, T. T. V., Hernandez, L. E. C., & de la Puente, S. G. (2020). Additional health care recommendations for children with Down syndrome. Journal of Pediatrics & Neonatal Care, 10(5), 148–154. https://doi.org/10.15406/jpnc.2020.10.00428
Beqaj, S., Jusaj, N., & Živković, V. (2017). Attainment of gross motor milestones in children with Down syndrome in Kosovo – Developmental perspective. Medicinski Glasnik, 14(2), 189–198. https://doi.org/10.17392/917-17
Bokhari, M. O., Mujallid, M. F., Alsulami, S. A., Milyani, A. A., Alsulami, M. A., Malatani, N. N., Al-Sharief, R. A., Alsolami, M. A., & Al-Agha, A. E. (2018). Autoimmunity and vitamin D deficiency in children affected with trisomy 21. Current Pediatric Research, 22(3).
Boyd, N. K., Nguyen, J., Khoshnood, M. M., Jiang, T., Nguyen, L., Mendez, L., Spinazzi, N. A., Manning, M. A., Rafii, M. S., & Santoro, J. D. (2023). Hypovitaminosis D in persons with Down syndrome and autism spectrum disorder. Journal of Neurodevelopmental Disorders, 15, 35. https://doi.org/10.1186/s11689-023-09503-y
Büyükavcı, R., & Büyükavcı, M. A. (2021). Vitamin D deficiency in preschool children with Down syndrome. Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Dergisi, 16(3), 397–400. https://doi.org/10.17517/ksutfd.798173
Capili, B. (2021). Cross-sectional studies. American Journal of Nursing, 121(10), 59–62. https://doi.org/10.1097/01.naj.0000794280.73744.fe
Eid, M. A., Ibrahim, M. M., Radwan, N. L., & Aly, S. M. (2022). Effects of vitamin D supplementation and aerobic exercises on balance and physical performance in children with Down syndrome. International Journal of Therapy and Rehabilitation, 29(2), 1–11. https://doi.org/10.12968/ijtr.2020.0162
Holick, M. F. (2009). Vitamin D status: Measurement, interpretation, and clinical application. Annals of Epidemiology, 19(2), 73–78. https://doi.org/10.1016/j.annepidem.2007.12.001
Jain, P. D., Nayak, A., Karnad, S. D., & Doctor, K. N. (2021). Gross motor dysfunction and balance impairments in children and adolescents with Down syndrome: A systematic review. Clinical and Experimental Pediatrics, 65(3), 142–149. https://doi.org/10.3345/cep.2021.00479
Kazemi, M., Salehi, M., & Kheirollahi, M. (2016). Down syndrome: Current status, challenges and future perspectives. International Journal of Molecular and Cellular Medicine, 5(3), 125–133.
Lauteslager, P. E. (2004). Children with Down’s syndrome: Motor development and intervention [Doctoral dissertation, Heeren Loo Zorggroep].
Lauteslager, P. E. M., Volman, J. M., Lauteslager, T., Van den Heuvel, M. E., Jongerling, J., & Klugkist, I. G. (2020). Basic motor skills of children with Down syndrome: Creating a motor growth curve. Pediatric Physical Therapy, 32(4), 375–380. https://doi.org/10.1097/pep.0000000000000743
Mutua, A. M., Nampijja, M., Elliott, A. M., Pettifor, J. M., Williams, T. N., Abubakar, A., Webb, E. L., & Atkinson, S. H. (2020). Vitamin D status is not associated with cognitive or motor function in pre-school Ugandan children. Nutrients, 12(6), 1662. https://doi.org/10.3390/nu12061662
Praticò, A. D., Lo Bianco, M., Leonardi, R., Polizzi, A., & Ruggieri, M. (2024). The impact of vitamin D supplementation duration on early childhood developmental milestones: A retrospective study. Nutrients, 16(24), 4395. https://doi.org/10.3390/nu16244395
Rodgers, M. D., Mead, M. J., McWhorter, C. A., Ebeling, M. D., Shary, J. R., Newton, D. A., Baatz, J. E., Gregoski, M. J., Hollis, B. W., & Wagner, C. L. (2023). Vitamin D and child neurodevelopment—A post hoc analysis. Nutrients, 15(19), 4250. https://doi.org/10.3390/nu15194250
Rodríguez-Grande, E.-I., Buitrago-Lopez, A., Torres-Narvaez, M.-R., Serrano-Villar, Y., Verdugo-Paiva, F., & Ávila, C. (2021). Therapeutic exercise to improve motor function among children with Down syndrome aged 0 to 3 years: A systematic literature review. Research Square. Advance online publication. https://doi.org/10.21203/rs.3.rs-1080112/v1
Shields, N. (2021). Physiotherapy management of Down syndrome. Journal of Physiotherapy, 67(4), 243–251. https://doi.org/10.1016/j.jphys.2021.08.016
Shin, M., Siffel, C., & Correa, A. (2010). Survival of children with mosaic Down syndrome. American Journal of Medical Genetics Part A, 152A(3), 800–801. https://doi.org/10.1002/ajmg.a.33295
Stagi, S., Lapi, E., Romano, S., Bargiacchi, S., Brambilla, A., Giglio, S., Seminara, S., & de Martino, M. (2015). Determinants of vitamin D levels in children and adolescents with Down syndrome. International Journal of Endocrinology, 2015, 1–11. https://doi.org/10.1155/2015/896758
Supriadi, S., Setiabudi, D., Noviandhari, A., Judistiani, R. T. D., Setiabudiawan, B., & Dhamayanti, M. (2022). Correlation between cord blood vitamin D levels and problem-solving neurodevelopment in early childhood: A cohort study in rural Indonesia. Children, 9(10), 1581. https://doi.org/10.3390/children9101581
Tavakolizadeh, R., Ardalani, M., Shariatpanahi, G., Mojtahedi, S. Y., & Sayarifard, A. (2019). Is there any relationship between vitamin D deficiency and gross motor development in 12-month-old children? Iranian Journal of Child Neurology, 13(3), 55–60.
Valle, M. S., Russo, C., Surdo, S., Cambria, M. T., Campanella, M., Tuttobene, M., & Malaguarnera, L. (2025). Pathophysiological role of Vitamin D deficiency in Down syndrome: Insights into metabolic dysfunction and sarcopenia. International Journal of Molecular Sciences, 26(21), 10756. https://doi.org/10.3390/ijms262110756
van den Heuvel, M. E., de Jong, I., Lauteslager, P. E. M., & Volman, M. J. M. (2009). Responsiveness of the test of basic motor skills of children with Down syndrome. Physical & Occupational Therapy in Pediatrics, 29(1), 71–85. https://doi.org/10.1080/01942630802574890
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., Vandenbroucke, J. P., & for the STROBE Initiative. (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. PLoS Medicine, 4(10), e296. https://doi.org/10.1371/journal.pmed.0040296
Weiler, H. A., Hazell, T. J., Majnemer, A., Vanstone, C. A., Gallo, S., & Rodd, C. J. (2022). Vitamin D supplementation and gross motor development: A 3-year follow-up of a randomized trial. Early Human Development, 171, 105615. https://doi.org/10.1016/j.earlhumdev.2022.105615
Wicklow, B., Gallo, S., Majnemer, A., Vanstone, C., Comeau, K., Jones, G., L’Abbe, M., Khamessan, A., Sharma, A., Weiler, H., & Rodd, C. (2015). Impact of vitamin D supplementation on gross motor development of healthy term infants: A randomized dose-response trial. Physical & Occupational Therapy in Pediatrics, 36(3), 330–342. https://doi.org/10.3109/01942638.2015.1050150
Wielders, J. P. M., Carter, G. F., Eberl, H., Morris, G., Roth, H. J., & Vogl, C. (2014). Automated competitive protein‐binding assay for total 25‐OH vitamin D, multicenter evaluation and practical performance. Journal of Clinical Laboratory Analysis, 29(6), 451–461. https://doi.org/10.1002/jcla.21793
World Medical Association. (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. The Journal of the American Medical Association, 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053
Zhang, Y., Zhou, C.-Y., Wang, X.-R., Jiao, X.-T., Zhang, J., Tian, Y., Li, L.-L., Chen, C., & Yu, X.-D. (2023). Maternal and neonatal blood vitamin D status and neurodevelopment at 24 months of age: A prospective birth cohort study. World Journal of Pediatrics, 19(9), 883–893. https://doi.org/10.1007/s12519-022-00682-7
Zhu, P., Tong, S.-L., Hao, J.-H., Tao, R.-X., Huang, K., Hu, W.-B., Zhou, Q.-F., Jiang, X.-M., & Tao, F.-B. (2015). Cord blood vitamin D and neurocognitive development are nonlinearly related in toddlers. Journal of Nutrition, 145(6), 1232–1238. https://doi.org/10.3945/jn.114.208801
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