Objective To develop a nutritional literacy assessment scale for patients with decompensated liver cirrhosis and to evaluate its reliability and validity.Methods Based on Nutbeam′s health literacy framework, the Nutritional Literacy Assessment Scale for Patients with Decompensated Liver Cirrhosis was constructed through literature review, qualitative interviews, expert consultations, and pre-testing.A convenience sampling method was used to select 406 patients with decompensated liver cirrhosis who visited a tertiary hospital in Jiangsu Province from November 2023 to October 2024 for questionnaire survey to assess the scale′s reliability and validity.Results The scale consisted of 24 items.Exploratory factor analysis extracted three common factors:nutritional attitudes and knowledge comprehension, information interaction and judgment, and application of nutritional practice skills, with a cumulative variance contribution rate of 66.234%.Confirmatory factor analysis indicated that χ2/df=2.319, GFI=0.805, CFI=0.910, TLI=0.900, and RMSEA=0.070.The scale-levle content validity index was 0.910, and the item-level content validity index ranged from 0.800 to 1.000.The Cronbach′s α coefficient of the scale was 0.962, with a split-half reliability coefficient of 0.889 and a test-retest reliability coefficient of 0.937.Conclusion The assessment scale decompensates good reliability and validity, justifying its use as an effective tool for assessing the nutritional literacy level of patients with decompensated liver cirrhosis.