The effects of oral nutritional interventions on functional and nutritional outcomes in nutritionally vulnerable individuals are inconsistent, thus parallel therapies to enhance therapeutic management warrant exploration (1) . Physical activity, shown to attenuate the inflammatory response (2) and enhance appetite (3) , is a cost effective and accessible option (4) . This systematic review and meta-analysis synthesizes the evidence for nutritional intervention and physical activity combined compared to nutrition alone, exercise alone or routine care in nutritionally vulnerable individuals.Searches of 5 electronic databases and bibliographies were undertaken to September 2011. Trials comparing oral nutritional intervention and exercise with (1) nutritional intervention alone, (2) exercise alone or (3) routine care were eligible for inclusion. Data on energy intake, weight, fat free mass, strength and gait were entered into a meta-analysis using Review Manager 5.0.23 randomised controlled trials (RCTs) were identified (n = 1430 participants) including elderly (11 RCTs), COPD (2 RCTs), HIV (2 RCTs), critical illness (1 RCT), renal disease (2 RCTs), muscle wasting (1RCT) and osteo-degenerative disease (4 RCTs). Duration of follow up ranged from 7 to 78 weeks. 10 studies compared combined intervention with nutritional alone, 11 with exercise alone and 12 with routine care. 7 studies included comparisons in more than one part of the review. Two studies provided no usable data. One study included personalized dietary counseling, with no food or oral nutritional supplementation, as the nutritional intervention and accounted for all of the heterogeneity in analyses; results are presented with this study removed (3) . All studies were judged to be at risk of bias for one or more characteristic. Nutritional intervention combined with physical activity is associated with significant improvements in energy intake compared with either therapy alone or routine care and may result in improvements to weight and functional improvements. Nutritional intervention given in combination with exercise has promising effects on energy intake but larger studies are needed to investigate whether these increases have effects on clinical, functional and patient centred endpoints.

AimsObesity in children and young people in the United Kingdom is increasing in prevalence. The responsibility of paediatricians extends to the promotion of healthy eating; balanced nutrition being of increased importance for the unwell child. The presented study evaluates the food options readily available to children in a large district general hospital, against a healthy eating model as suggested by NICE Quality Standard 94.MethodFood options presented in hospital vending machines, served on the children’s ward and in the canteen were analysed for the proportion of healthy options and availability of nutritional information at the point of selection.ResultsVending machines; 22% of the items displayed clear nutritional information. Available products comprised of chocolate (28%), biscuits (21%), crisps (19%) and artificial drinks (11%). Natural drinks accounted for 4% of the contents. Ward; A daily menu is used throughout the hospital, serving only adult portions on the paediatric wards. The menu delineates healthy options with a heart symbol (37%), meals with high energy (31%), softer diet (46%), vegetarian options (56%) and gluten free options (54%). Full nutritional breakdown is available only on request. Canteen; Items produced on site have a ticket detailing energy, total fat, saturates, sugar and salt content per adult portion. 86 menu items were analysed. 68% of main dishes, 22% of sides, 80% of desserts and 57% of breakfast items were classified as ‘unhealthy’, (Department of Health guidance for nutritional labelling).ConclusionThe range of food available in hospital is skewed to an unhealthy predominance. Nutritional information is displayed inconsistently and with ambiguity, challenging parental decision making for healthier choices. A unified, comprehensible system is required throughout the catering services.ImplementationA collection of posters and leaflets designed to demonstrate the importance of healthy eating and exercise has been created to display across the hospital and distribute to parents and children to educate patient choices. In collaboration, work continues towards implementing the nationally recommended traffic light approach to food labelling across hospital catering services and adjusting the selection at vending machines to offer healthier options.