The quintessence of the intended investigation rests upon the immense medicinal potential and nutritive value of wheat produce viz, wheat germ, wheat grass and wheat bran as they are capable of addressing the health of malnourished as well as obese population: a commonly seen amalgamation in all developing countries especially as ours. As a pioneering study the researcher sets out to study the effect of supplementation of wheat germ, grass and bran in subjects with specific health issues. Prima facie, the present study warrants for a multi-disciplinarian approach: Physicians for identification of patients; biochemists for making critical analysis of the outcome of the result while the investigation rests on the pedestal of Food 11 Science and Nutrition. The scope of the study not only confines to laboratory investigations but to the community on the whole.That wheat is a familiar crop and thrives well in Indian climatic conditions; the cost-effectiveness for even a state sponsored supplementation of the proposed recipe to the poor population could be well affordable in the existing economy. As such the present study attains not only a discipline oriented relevance but also a valid social relevance.  Wheat germ Long-term studies in the Department of Internal Medicine, Washington University, St.Louis on consumption of wheat germ by hypercholesterolemic human subjects have shown the beneficial effects on plasma lipids and lipoproteins. Through this investigation, the hypothesis has been validated with respect to hyperchlosterolemic population only. Wheat germ has brought about a decrease in the lipid profile without altering biomarkers of bone metabolism in postmenopausal women. 

The quintessence of the intended investigation rests upon the immense medicinal potential and nutritive value of wheat produce viz, wheat germ, wheat grass and wheat bran as they are capable of addressing the health of malnourished as well as obese population: a commonly seen amalgamation in all developing countries especially as ours. As a pioneering study the researcher sets out to study the effect of supplementation of wheat germ, grass and bran in subjects with specific health issues. Prima facie, the present study warrants for a multi-disciplinarian approach: Physicians for identification of patients; biochemists for making critical analysis of the outcome of the result while the investigation rests on the pedestal of Food 11 Science and Nutrition. The scope of the study not only confines to laboratory investigations but to the community on the whole.That wheat is a familiar crop and thrives well in Indian climatic conditions; the cost-effectiveness for even a state sponsored supplementation of the proposed recipe to the poor population could be well affordable in the existing economy. As such the present study attains not only a discipline oriented relevance but also a valid social relevance.  Wheat germ Long-term studies in the Department of Internal Medicine, Washington University, St.Louis on consumption of wheat germ by hypercholesterolemic human subjects have shown the beneficial effects on plasma lipids and lipoproteins. Through this investigation, the hypothesis has been validated with respect to hyperchlosterolemic population only. Wheat germ has brought about a decrease in the lipid profile without altering biomarkers of bone metabolism in postmenopausal women. 

Laboratory experiments at National Institute of Health and Medical Research, Marseille, France have proved that fermented wheat germ extract has reduced chemotherapy-induced febrile neutropenia in pediatric cancer patients. Wheat germ supplement reduces cyst and trophozoite passage in people with giardiasis. The bioavailability and possible benefits of wheat germ intake naturally enriched with selenium and its products is proved to be a boon to the decrease in symptoms of serenity. Wheat bran Studies at the Department of Pediatrics, School of Medicine, Semmelweis University, Hungary on wheat bran have identified the preventive potential of wheat bran fractions against experimental colon carcinogenesis. After meticulous study it has been concluded that wheat bran has human colon cancer preventive properties. Wheat bran and oat bran has effectively reduced oxidative stress induced by high-fat diets in pigs. Study on the effect of wheat bran fiber supplementation on bone loss in older people has concluded that it made no significant change. The supplementation of wheat bran to improve risk profile in patients with dysmetabolic cardiovascular syndrome has yielded significant positive impact. It is found that consumption of wheat fibre resulted in a significant decrease of systolic and diastolic blood pressure and glucose. Suppressive effects of dietary fiber in wheat bran fibre on the postprandial serum lipid levels in healthy adult male volunteers have been recorded experimentally. Oxidative stress and metabolic shifting for cardiac health on supplementation of wheat bran fibre to selected adults has been proved. 

Studies have also asserted that dietary fibre supplementation, rather than energy intake and dietary restriction, appears to be the main process retarding oxidative stress in cardiac tissues. Wheat grass Studies from the Department of Food Science and Nutrition, Clemson University, South California have identified that chlorophyll present in wheat grass had the potential to neutralize infections, heal wounds, overcome inflammations and get rid of parasitic infections. Through investigations, it has been found that wheat grass is an excellent source of vitamin C, E, beta carotene and vitamin B. It is also said to contain 90 different minerals, 19 amino acids and more iron than spinach and more protein than meat, fish, egg, beans or dairy products. Zinc and selenium in highly bio-available form is available. The most vital ingredient of wheat grass is chlorophyll and hence called by a pet name “concentrated solar energy”. Wheat grass juice contains significant concentration of folic acid, which may lead to reduction of high blood pressure. The role of wheat grass in reducing blood pressure has been established. Wheat grass juice supplementation to cancer patients has also proved to have a positive impact on them. Significance of the Study The present study attains significance under the pretext that the studies in India have not adequately exploited the vitality of wheat in the forms of germ, grass and bran. The present study is intended to fill this gap. The bountiful production of wheat and its high consumption among Indian populace are the encouraging factors for this intended investigation that attains social relevance too. 

 In the second phase, various nutritious and cost effective recipes were standardized incorporating wheat germ / grass / bran. In the third phase wheat germ, grass and bran was supplemented individually and in combination to human subjects to treat specific health problems and the impact was evaluated. Phase I Macro and micro nutrients in wheat germ , grass and bran was analyzed by the standard procedures of National Institute of Nutrition (NIN,1999).The amino acid profile, fatty acids, sterols and the total dietary fibre content (both soluble and insoluble) was analyzed (AOAC, 2000) Phase II Recipes including breakfast/ lunch /dinner items and snacks where there would be acceptable incorporation were formulated and standardized using the wheat germ, grass and bran individually as well as in combinations (wheat germ and grass; wheat germ and bran; wheat grass and bran; wheat germ, wheat grass and bran) by various methods of cooking.In order to test the acceptability of the recipes sensory evaluation test was done by semi trained panel members using triangle test of nine point hedonic rating scale. Phase III As a first step in the supplementation study an interview schedule was formulated to elicit information from all the 105 diabetic, 60 low immune and 105 obese subjects on their socioeconomic details including age, sex, education, family type, monthly income, food habits and dietary pattern through interview cum observation method. Details on type and duration of disease and familial disposition of disease were also collected. A pilot study was performed on five per cent of the selected sample as suggested by Kothari (2005) before the conduct of the survey.

 Based on the results, relevant modifications were made and the proforma was finalized (Appendix I). The investigator administered the interview schedule to all the subjects and required information was collected. A. Assessment of anthropometric measurements and diet survey of the subjects 1. Anthropometric measurements Anthropometrics is the gold standard for assessment of nutritional status (Elizabeth, 2000). To add, anthropometry is the single point portable invasive method of assessing body composition reflecting health and nutrition and predicting performance, health and survival (Ramalingaswami, 1993). While height is used to assess the past nutritional status, weight helps to assess the present. Body Mass Index (BMI) is frequently used as a popular and rapid clinical measure of relative obesity and malnutrition (Priyatomako et al., 2001). Accordingly, the anthropometric indicators namely weight (kg), height (cm), BMI (kg/m2 ), waist and hip circumferences were measured for all the 105 subjects in the diabetic and obese groups respectively before and after the supplementation period. Genton et al., (2005) suggest that in conditions like low immune where underweight is predominant the only useful parameter is anthropometrics and that would be weight loss, perhaps Mid Upper Arm Circumference (MUAC) and skinfold thickness. Therefore MUAC and skinfold thickness were assessed along with height, weight and BMI for all the 60 low immune subjects. a. Weight Measurement of weight serves as the indicator to profess the presence and progress of ailment. 

The weight of all the selected subjects in the three groups were determined by making them stand barefooted and erect on a portable weighing scale to the accuracy of 0.1kg before supplementation (Brahmam et al., 2005). b. Height Height is a constituent factor in the calculation of BMI and hence the height of all subjects was measured using a vertical measuring rod (anthropometer). The subjects were made to stand erect, barefooted on a levelled surface, with heels together and toes apart. The moving head piece of the anthropometer was placed in the sagital plane over the head of the subjects applying a slight pressure to reduce the thickness of hair. The reading was taken when the anthropometer was still in position to the accuracy of 0.1cm (Brahmam et al., 2005). c. Body Mass Index (BMI) BMI determines if weight is appropriate for the height and thus has good correlation with fitness (Bamji et al., 2004). WHO (2000) has explained BMI as a simple index of weight for height that is commonly used to classify adults as underweight or overweight. BMI was calculated for all the selected subjects in the three groups using the following formula: Waist circumference Waist circumference was measured for all the selected subjects. The subjects were asked to stand erect with weight evenly balanced on both feet, which were placed about 25 to 30 cm apart. A mark was made at the level of the lowest rib margin. The iliac crest in the mid axillary line was felt and a mark was made. The measuring tape was passed around the waist horizontally midway between the lowest rib margin and iliac crest and the circumference in centimeter was measured upto the nearest millimeter.

 The observer sat on a stool in front of the subjects while taking the measurement (Brahmam et al., 2005). e. Hip circumference Hip circumference was measured for all the subjects. For measuring the hip circumference, the measuring tape was placed horizontally over the buttocks and the circumference was measured at the point yielding the maximum circumference in centimeter upto the nearest millimeter (Brahmam et al., 2005). According to Boyle et al., (2001) the waist circumference should be taken at the narrowest circumference between ribs and hips. For all the selected subjects in the diabetic and hyperlipidemic groups Waist Hip Ratio (WHR) was computed by dividing subject’s waist circumference in centimeter by hip circumference in centimeters. f. Mid Upper Arm Circumference (MUAC) MUAC was measured for all the 60 low immune subjects. Assessment of protein compartments (muscle) can aid in the diagnosis of clients with wasting. MUAC provides an estimate of lean tissue and muscle mass of the patients and hence is a good indicator of wasting and weight loss. The MUAC was taken on the left forehand at the mid point between the tip of the acromion of scapula and the tip of the olecranon of the forearm bone of the patients. The arm was left freely hanging and flexible tape was used to measure the MUAC to the nearest millimetre with the tape still in position.  Skin fold thickness Skin fold thickness is a measure of subcutaneous fat reserves which was evaluated for all the 60 low immune subjects. The skin fold at triceps is more reliable than that of sub scapular in the assessment of underweight and is more sensitive to the socio economic environment (Knechtle and Kohler, 2007). Triceps skin fold thickness was mid point where MUAC was measured.

 The skin fold was picked up between the thumb and the forefinger about one centimeter above the midpoint, taking care not to include the underlying muscle. The calipers were squeezed until they were equilibrated at the point for approximately three seconds. The measurements were read to the nearest millimetre and calibrated using previously published empirical equation (Felbinger, 2003). 2. Diet survey According to Bamji et al., (2004), diet is a vital determinant of health and nutritional status of people. Precise information of food consumption pattern of people through application of appropriate methodology is often needed not only for assessing the nutritional status of people, but also for elucidating the relationship of nutrient intake with deficiency as well as degenerative diseases. Precise information on food consumption pattern was collected through 24 hour recall method for one tenth of the selected subjects in all the three groups studied. The raw food equivalent of the cooked food was determined and the intake of macro and micro nutrients were computed using the values given in the ‘Nutritive Value of the Indian Foods’ (ICMR, 2004). B. Supplementation of wheat germ, bran and grass to diabetic, obese and low immune subjects 1. Grouping of subjects Sampling is the selection of some part of an aggregate or totality on the basis of which a judgment or inference about the aggregate or totality is made. For the present study purposive sampling method was adopted, as the method has definite view point in selection, considering the nature, scope and criteria fixed for the study (Burney, 2003). 

The selection of subjects for the study, mainly depended on the discretion of the investigator, keeping in view the criteria fixed for the study. During the initial rapport with the selected subjects, willingness to participate and cooperate till the completion of study was sought from the interview and obtained in the form of a consent letter. The 105 diabetics and 105 hyperlipidemics were divided randomly into seven groups of 15 each respectively. Group A received wheat germ, group B received wheat bran, group C received wheat grass, group D received wheat germ and bran, group E received wheat germ and grass and group F received wheat bran and grass as supplements. Group G served as the control group and did not receive any supplements other than the usual medications. Wheat bran’s nutraceutical potential in alleviating symptoms of certain diseases were correlated only with the high insoluble fibre content (Borel et al., 2005). Further the experienced physicians suggested that wheat bran supplementation would irritate the bowel movements of low immune subjects and also inhibit the absorption of the medication. Thereby the supplementation of wheat bran to the low immune subjects was forgone on ethical reasons and only 60 low immune subjects were selected and divided into four groups of 15 each. Group A received wheat germ, group B received wheat grass and group C received wheat germ and grass as supplement. Group D served as the control group and did not receive any supplements. Figure I gives the grouping of subjects and the supplements tested.