Sarcopenia in patients with cirrhosis is caused and exacerbated by multiple factors, such as portal hypertension, pro-inflammatory cytokines, hyperammonemia, administration of loop diuretics, hypotestosteronemia, physical inactivity, elevated hepatic gluconeogenesis, impaired insulin/IGF-1 signaling, and excessive alcohol consumption [22]. Here, IGF1 is linked to portal hypertension.