Agreement of Nutritional Assessment in Hospitalized Patients between the Bhumibol Nutritional Triage and Body Mass Index

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Ekkawit Iamthongin


Background : Malnutrition is commonly found in hospitalized adult patients and usually neglected by the health care team. One of its recommended screening tools in Thailand is Bhumibol Nutrition Triage (BNT) whereas many hospitals used only body mass index (BMI) as a single criterion (according to WHO) for diagnosis and reimbursement. There was no previous study about the accuracy of BMI alone for being a nutritional screening or diagnostic tool, especially in community or provincial hospital.
Objectives: To study the agreement of nutritional assessment in hospitalized patients between BNT and BMI.
Material and method: A cross-sectional study was conducted on hospitalized adult patients in Chomtong hospital between September 2011 and February 2012. Those risky patients underwent malnutrition screening with BNT and BMI by using the intranet computerized program. Demographic data and malnutrition prevalence were analyzed. The agreement between BNT and BMI to classify the malnutrition level was obtained by Kappa analysis
Results: Among 4,147 hospitalized patients, 642 (15.5%) accomplished initial screening, 473 patients were found risky and enrolled the study to be screened with intranet-computerized BNT. The mean age was 58.3 ± 18.8 years. Male is slightly more than female. They were most commonly found in surgical ward. The prevalence of malnutrition was 14.3% by BNT and 23.8% by BMI criterion. The agreement between BNT and BMI to classify 4-level of nutritional status (normal, mild, moderate and severe) was poor (kappa = 0.008, p=0.769). The agreement of both tools to classify 2-group of patients according to the need of nutritional support was poor (kappa=0.164, p<0.001).
Conclusion: The agreement between BNT and BMI to classify either 4-level of nutritional status or 2-group of patients according to the need of nutritional support was poor. BMI alone should not be the appropriate indicator of nutritional status in hospitalized patients.


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Iamthongin, E. . (2022). Agreement of Nutritional Assessment in Hospitalized Patients between the Bhumibol Nutritional Triage and Body Mass Index. Lampang Medical Journal, 34(1), 1–10. Retrieved from
Original Article


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