Nutritional status, health literacy, and lifestyle factors associated with health-related quality of life in patients with decompensated cirrhosis: a cross-sectional study

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Background Liver cirrhosis is one of the leading causes of liver-related mortality worldwide. The disease typically progresses from an initially asymptomatic, compensated phase to decompensation, which adversely affects patients’ health-related quality of life (HRQoL). Identifying the factors that influence HRQoL and implementing effective interventions are essential for improving patient outcomes. Based on the health ecology theory, this study focuses on health literacy and nutritional status, with the aim of enhancing patients’ quality of survival through targeted interventions. Methods A cross-sectional design was employed, using convenience sampling to recruit 202 patients with decompensated cirrhosis. Data collection included demographic information, biochemical indicators, and scores on health literacy, nutritional status, and HRQoL. Using IBM SPSS Statistics version 27, correlation analysis and multiple linear regression were conducted to primarily explore the associations of nutritional status, health literacy, and lifestyle factors with HRQoL. Results Correlation analysis showed that health literacy, nutritional status, sleep quality, and physical activity were significantly associated with patients’ quality of life. Multiple linear regression revealed that nutritional status was independently associated with the HRQoL; notably, the model’s explanatory power for HRQoL significantly increased ( R Square increment) when health literacy was introduced, indicating practical significance. Furthermore, regression analyses showed that communication ability ( B = −0.177, p = 0.007), walking ( B = −1.589, p = 0.007), and aerobic exercise ( B = −1.739, p = 0.017) as significant predictors of the physical dimension. Poor sleep significantly predicted both dimensions (physical: B = 1.193, p = 0.032; psychological: B = 0.532, p = 0.001), while information acquisition ability ( B = −0.028, p = 0.021) specifically predicted the psychological dimension. Conclusion This study demonstrated that both health literacy and nutritional status were significantly associated with the HRQoL among patients with decompensated cirrhosis. These findings may inform the design of targeted interventions to enhance health literacy and nutritional status, which may be beneficial for promoting self-management and improving clinical outcomes. Furthermore, they support the development of individualized management strategies.