Hepatic encephalopathy (HE) is a frequent neuropsychiatric complication of advanced liver disease characterized by a spectrum of cognitive, behavioural and motor impairments that compromise patient safety and functional independence. Its pathophysiology is multifactorial, involving hyperammonaemia, systemic inflammation, oxidative stress and astrocyte swelling with consequent neurotransmission disturbances. Particular attention is warranted for minimal hepatic encephalopathy (MHE), a subclinical yet prevalent form preceding overt HE, associated with impaired psychomotor performance, increased hospitalization rates and diminished health-related quality of life. Given the high prevalence of malnutrition and sarcopenia in cirrhosis, nutritional intervention is integral to management. Current recommendations include 30–35 kcal/kg/day and 1.2–1.5 g/kg/day of protein, preferentially plant-based. Additional strategies comprise frequent meals, late-evening carbohydrate supplementation, micronutrient repletion and preference for enteral nutrition. Early recognition and multidisciplinary management are essential to optimize neurological and functional outcomes.