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The current recommendation is for patients with HE to maintain the same diet as other patients with cirrhosis, because there is no evidence that dietary protein restriction prevents episodes of HE.38,39 Despite the effort to maintain their nutrition, certain patients with cirrhosis present with sarcopenia and there is evidence suggesting that said loss of skeletal muscle mass is associated with the risk for developing minimal HE or overt HE.40,41 In theory, HE prevention could be helped by attempting to improve nutritional status and muscle mass through a protein-rich diet and a high-protein snack before going to bed.38,42 In addition, exercise and branched-chain amino acids have been studied as therapeutic options for treating sarcopenia in patients with cirrhosis and the results have been satisfactory.43 Branched-chain amino acids were also analyzed in a Cochrane review as a therapeutic option for HE, and they were shown to significantly increase the number of patients that had HE improvement.44 Increased expression of myostatin or growth differentiation factor 8 (GDF-8) belonging to the transforming growth factor- (TGF-) family of proteins was shown in the muscle mass of cirrhotic patients

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The study found that the high calcium group experienced a 22% increase in GLP-1 compared to the low calcium group