Malnutrition is common in human patients with end-stage liver failure and associated hepatic encephalopathy, and is known to affect quality of life, outcome, and survival. Many factors contribute to malnutrition in hepatic failure. These include inadequate energy intake, malabsorption, increased protein losses, hypermetabolism, insulin resistance, gastrointestinal bleeding, ascites, inflammation/infection, and hyponatraemia. Patients at risk of malnutrition are relatively difficult to identify because liver disease can interfere with biomarkers of malnutrition. Patients with end-stage liver failure may benefit from supplementation of their diet with amino acids, antioxidants, vitamins and probiotics.