Cirrhosis of the liver imposes a substantial health toll, being responsible for upwards of 1 million deaths annually across the world. The trajectory of hepatic illnesses, most notably cirrhosis, is often worsened by nutritional disturbances, and these have been tied to elevated mortality. Despite this heavy disease burden, studies examining the scale of under-nutrition and its determinants among cirrhotic individuals in Ethiopia and the broader sub-Saharan African region remain scarce. The present investigation sought to determine the prevalence of under-nutrition and identify its correlates among adult patients with liver cirrhosis managed on an outpatient basis. A cross-sectional, hospital-based design was employed, enrolling 136 adult outpatients with cirrhosis who presented to the hepatology unit of St. Paul’s Hospital Millennium Medical College. Data collection relied on structured checklists and included patient interviews, medical file reviews, anthropometric evaluations, and handgrip strength assessments; analysis was performed using Statistical Package for the Social Sciences (SPSS) version 26.0. Under-nutrition was defined using body mass index thresholds modified for ascites severity. Descriptive statistics, along with binary and multivariable logistic regression, were utilized, adopting a significance level of < 0.05. Participants had a mean age of 39.5 years (standard deviation: ± 11.2), and 62.5% were men. Chronic infection with the hepatitis B virus (57.4%) stood out as the leading etiology of cirrhosis, with alcohol-related liver cirrhosis (12.5%) ranking second. A large proportion (70.6%) of the subjects were classified as undernourished. Variables exhibiting independent statistical links to under-nutrition comprised residing in a rural setting (adjusted odds ratios [AOR]: 5.65, 95% confidence interval [CI]: 1.98–16.1), having ascites (AOR: 2.43, 95% CI: 1.03–5.7), and the extent of hepatic impairment per Child–Pugh categorization (AOR, 1.11; 95% CI: 0.45–2.7). Under-nutrition proved to be a widespread concern among ambulatory cirrhosis patients, with rural dwellers and individuals at advanced disease stages carrying a disproportionate burden. Instituting systematic nutritional screening and developing appropriate intervention strategies for cirrhotic patients is critically needed
