Introduction: Disease-related malnutrition (DRM) is a frequently underestimated complication in end-stage liver disease (ESLD) patients awaiting liver transplantation (LT). This study aimed to assess the prevalence of malnutrition using multivariate tools and evaluate the impact of nutritional intervention on clinical outcomes. Methods: A prospective, single-center study was conducted from October 2014 to April 2018 involving adult patients listed for LT who met the inclusion criteria and provided informed consent. Data collected included demographic details, clinical parameters, anthropometry, handgrip strength (HGS), dietary intake, and nutritional assessments. Statistical analysis was performed using SPSS version 25.0. Results: Of 401 patients screened, 291 met the inclusion criteria and had complete data available, were included. The mean age was 49.9±8.5 years, with 84.5% men and 68.4% in Child-Turcotte-Pugh class C. The mean MELD score was 20.5±5.7, with 20.6% scoring >25. Based on mSGA, 85% were moderately malnourished and 4% severely malnourished (mean score 19.9±4.0). GLIM classified 66% as severely malnourished, while RFHGA identified 84.5% as moderately and 9.3% as severely malnourished. Mean HGS was 23.1±8.1 kg; BMI was 26.4±5.3 kg/m². Nutritional support significantly improved achievement of ?80% energy (p<0.0001) and protein (p=0.0004) targets. Among 98 patients on the LT waiting list, 55.1% died during waiting period. Higher MELD scores, severe malnutrition by mSGA/RFHGA, and HGS <19.5 kg were significantly associated with pre-LT mortality (p<0.05). Step-wise logistic regression analysis indicated that baseline MELD >25 and low HGS were independent predictors of mortality. Conclusion: Early identification and intervention for malnutrition significantly improve nutritional status and reduce pre-transplant mortality in ESLD patients.