A Deficiency State Arising in Infants on Synthetic Foods

Severe extensive skin eruptions coupled with failure to thrive have been observed in infants fed on a synthetic low-phenylalanine diet (Moncrieff and Wilkinson, 1961; Brimblecombe, Blainey, Stone- man, and Wood, 1961; Wilson and Clayton, 1962).An investigation of this problem by Wilson and Clayton (1962) drew attention to the need to consider all nutrients carefully when constructing synthetic diets.The interdependence of various nutritional factors and the rapidity with which deficiencies could develop in infancy were particularly stressed.The publication of this work led one of us (T.P.M.) to realize that he had observed rashes somewhat similar to those described by Wilson and Clayton in galactosaemic infants receiving the low lactose-containing food, Galactomin (Trufood Ltd.).Similar features have subsequently been observed in 3 infants, one receiving a low sodium milk (Edosol, Trufood Ltd.), another low calcium milk (Locasol, Trufood Ltd.), and a third fed low lactose milk (Low lactose milk food, Cow and Gate Ltd.).These synthetic milks are prepared by precipitating the casein in cows' milk, washing it to free it from other components and then mixing it with carbo- hydrate, fat, and a mineral mixture using a spray- drying process.During the initial precipitation and washing procedure, many nutrients are washed out too.Vitamins Bi, B2, and nicotinamide are added to Edosol and Locasol, but not to Galactomin* or Low lactose milk food.Edosol also contains added vitamins A and D.The nutritional properties of these four milks have been studied in weanling rats, and in the light of our experiments recommendations can be made for suitable vitamin supplements, their efficacy having been demonstrated in some infants.* Trufood Ltd. have already taken note of the experimental and clinical findings reported in this paper, and Galactomin now contains added choline, and the label carries detailed advice about vitamin requirements. Milk Preparations StudiedGalactomin, Edosol, Locasol, and Low lactose milk food were fed to the infants as the preparations available commercially.Special batches of Edosol and Locasol, in which lactose was replaced by dextrimaltose, were used for the feeding experiments in rats, since lactose causes diarrhoea in this species (Mitchell, 1927).0Q3 g. sodium as sodium chloride and 0 6 g. calcium as calcium gluconate were added to 100 g. of Edosol and Locasol, respectively, in order to increase the amounts of sodium and calcium to the levels present in breast milk.Galactomin and Low lactose milk food were fed to rats as the preparations available commercially.The percentages of protein in Galactomin, Edosol, Locasol, and Low lactose milk food were 22 -3, 27 -8, 21 *4, and 27 -8, respectively of the dried food.Vitamin Preparations Details of the preparations of vitamins used for treating the infants, and for the feeding experiments in rats are shown in Table1.For the purpose of this communication the term 'vitamin' includes choline.Case Reports Two galactosaemic infants who developed the deficiency state while receiving Galactomin are described.Case 1. A.R., a female infant, aged 7 days, was admitted in June 1959, to the Royal Alexandra Hospital for Sick Children, Brighton, for further investigation of galactosaemia.On the 4th day of life galactose had been found in the urine while she was receiving breast milk.A previous child had been similarly affected, the diagnosis being made on the 10th day of life.On Galactomin there had initially been a good response in this other sib, but vomiting then occurred and she ceased to thrive normally.A soya-bean product was tried with no better response, and while still on this preparation and 364 copyright.