Objective To analyze the effects of the nutritional support program based on the nutritional risk assessment of the Royal Free Hospital-Nutritional Priority Tool (RFH-NPT) on the nutritional status, gastrointestinal hormone levels and liver function of elderly patients with liver cirrhosis. Methods A total of 98 elderly patients with liver cirrhosis in Department of Digestive and Respiratory Medicine, Hebi People’s Hospital from January 2024 to January 2025 were selected as the research subjects, and were divided into the basic group and the study group by randomized numerical table method. In the control group, 49 cases were given the conventional nutritional support program, while in the observation group, 49 cases were given the nutritional support program based on the nutritional risk assessment of RFH-NPT. Three months later, the nutritional status, gastrointestinal hormone levels, liver function and the incidence of complications of the two groups of patients were compared. Results After the intervention, the study group had significantly higher levels of total protein (TP), albumin (ALB), and transferrin (TF) compared to the control group (P<0.05). Additionally, the study group showed significantly lower levels of gastrin (GAS) and motilin (MTL) than the control group (P<0.05). After the intervention, the study group also exhibited significantly lower levels of alanine transaminase (ALT), aspartate transaminase (AST), and total bilirubin (TBIL) compared to the control group (P<0.05). Furthermore, the incidence of complications in the study group was significantly lower than that in the control group (P<0.05). Conclusion The nutritional support program based on RFH-NPT nutritional risk assessment can effectively improve the nutritional status of elderly patients with liver cirrhosis, down-regulate gastrointestinal hormone levels, improve liver function, and reduce the incidence of complications, which is superior to the conventional nutritional support program. This research provides a clinical practice reference for nutritional interventions in elderly patients with liver cirrhosis.