Chitterlings: rich in cholesterol, riskier to clean than to eat

Pooled feeding trials in healthy adults show that dietary cholesterol does move blood cholesterol: across 17 trials it raised total cholesterol by 11.2 mg/dL (95% CI 6.4 to 15.9), and across 14 trials LDL by 6.7 mg/dL. That meta-analysis looked at cholesterol from any food, mostly eggs, and its cohorts found no significant link with heart disease. Chitterlings are a concentrated source. USDA survey data give 275 mg cholesterol and 9.4 g saturated fat per 3.5 oz (100 g), about 344 mg of cholesterol in a 125 g cup, from a single record whose fat depends on how much was trimmed. The better documented danger comes before the pot. In a Tennessee outbreak of Yersinia in babies under one year, chitterlings had been prepared in the homes of all 10 interviewed cases against 35% of controls, and none of the babies had eaten them. The study is small, and the germ reached the infants through hands, bottles and pacifiers while the raw intestines were being cleaned.

As people eat it, per 3.5 oz (100 g)

How much is actually in it

• USDA survey data put cooked chitterlings at 231 calories, 20.2 g fat, 9.4 g saturated fat and 275 mg cholesterol per 3.5 oz (100 g), so a 125 g cup carries about 344 mg cholesterol. — FNDDS food code 25170210 Chitterlings, WWEIA Liver and organ meats (n = 1 record) Evidence E source
  Per 100 g: energy 231 calories, protein 12.39 g, fat 20.16 g, saturated fat 9.44 g, cholesterol 275 mg, sodium 325 mg, selenium 26.8 mcg, zinc 1.84 mg; per cup (125 g): 289 calories, cholesterol 344 mg, saturated fat 11.8 g

What a real portion looks like

• A dietary survey of about 1700 adults in the Lower Mississippi Delta found chitterlings among regional foods missing from national food-frequency questionnaires. — 842 white and 857 African American adults aged 19 and older, Lower Mississippi Delta, 24-hour recalls (n = 1699) Evidence C source
  Chitterlings, ham hocks, cracklings, grits and others absent from nationally used FFQs

What cooking and storage change

• Of 13 retail packs of frozen chitterlings tested after the Tennessee outbreak, 5 carried Salmonella, and investigators judged the thoroughly boiled dish likely safe while the cleaning step spreads bacteria. — 13 samples of frozen chitterlings bought in Tennessee grocery stores, February 2002 (n = 13 samples) Evidence C source
  5 of 13 positive for Salmonella, 2 of 13 for Yersinia intermedia

What it does to your health

• Across 17 feeding trials, extra dietary cholesterol raised serum total cholesterol by 11.2 mg/dL and, in 14 trials, LDL cholesterol by 6.7 mg/dL, while cohort links to heart disease were not significant. — Healthy adults; 19 trials with 632 subjects and 17 cohorts with 361,923 subjects (n = 632) Evidence A source
  Total cholesterol +11.2 mg/dL (95% CI 6.4 to 15.9, 17 trials); LDL-C +6.7 mg/dL (1.7 to 11.7, 14 trials); ischemic stroke RR 1.13 (0.99 to 1.28) in cohorts
• A review of 17 trials in 66,337 people found that swapping saturated for polyunsaturated fat cut nonfatal heart attacks by 25% in a subgroup analysis, with little or no benefit over 5 years for people at low cardiovascular risk. — Adults with or without cardiovascular disease, 17 randomized trials (n = 66337) Evidence A source
  Nonfatal MI RR 0.75 (95% CI 0.58 to 0.99) when replaced with polyunsaturated fat; all-cause mortality RR 0.96 (0.88 to 1.06); low to moderate certainty
• A meta-regression of 224 diet studies in 8143 people predicted that keeping cholesterol under 300 mg a day and saturated fat under 10% of energy lowers total and LDL cholesterol by about 5%. — 224 intervention studies, 8143 subjects, 1966-1994 (n = 8143) Evidence C source
  About 5% lower plasma total and LDL cholesterol vs the average American diet

Safety, limits and interactions

• In a Tennessee outbreak of Yersinia in infants, chitterlings had been prepared in the homes of all 10 interviewed cases versus 35% of controls, though none of the infants ate them. — Black infants under 1 year with culture-confirmed Yersinia enterocolitica, Tennessee, November 2001 to February 2002; 10 cases and 51 controls interviewed (n = 61) Evidence C source
  Home chitterling preparation 100% of cases vs 35% of controls (p < 0.001); 40% hospitalized; 70% bloody stools; median 4 days from preparation to symptoms
• A 12-year-old with poorly controlled diabetes developed enteritis necroticans from Clostridium perfringens type C after eating chitterlings and needed bowel resection. — One 12-year-old boy with poorly controlled diabetes, United States, December 1998 (n = 1) Evidence D source
  Extensive jejunal necrosis requiring resection; C. perfringens type C toxin genes detected by PCR
• A 10-year-old with sickle cell disease on deferoxamine for iron overload caught Yersinia after household exposure to raw chitterlings, and the authors advise withholding deferoxamine in such cases. — One 10-year-old girl with sickle cell disease on chelation therapy (n = 1) Evidence D source
  Y. enterocolitica enterocolitis mimicking appendicitis; improved after antibiotics and stopping deferoxamine
• A case report notes Yersinia is most often reported in infants through cross-contamination while cooking chitterlings, and that immunocompromised or iron-overloaded adults can develop sepsis with high fatality. — Review statement within a case report of an elderly man with Yersinia sepsis, northeastern United States (n = 1) Evidence D source
  Infants most affected via cross-contamination; sepsis risk in immunocompromised and iron-overload adults

The bottom line

Raw chitterlings from the shop can carry germs. After that outbreak, 5 of 13 frozen packs bought in Tennessee grocery stores carried Salmonella and 2 carried Yersinia intermedia. The investigators judged the thoroughly boiled dish likely free of bacteria, which was their reasoning and not a measurement. What they did record was how babies got exposed: a walker rolling around the room during cleaning, juice splashing onto a clean bottle, a pacifier handed over mid-task. If there is an infant in the house, that is the step to keep away from. Some people are more vulnerable to these germs, and the evidence for each group is a single case report. A 12-year-old with poorly controlled diabetes developed enteritis necroticans from Clostridium perfringens type C after eating chitterlings and needed part of his bowel removed. The authors extend the warning to preparing or eating them with any chronic illness. A 10-year-old with sickle cell disease on deferoxamine for iron overload caught Yersinia from raw chitterlings at home, and her doctors advise withholding deferoxamine when such a patient turns up with these symptoms. Authors of a third report write, as background and not as their own data, that immunocompromised or iron-overloaded adults can develop Yersinia sepsis with a high fatality rate. We found no study of chitterlings in pregnancy or kidney disease. On fat, a review of 17 trials in 66,337 adults found that replacing saturated fat with polyunsaturated fat cut nonfatal heart attacks by 25% (RR 0.75, 95% CI 0.58 to 0.99) in a subgroup analysis. The same review concluded that people at low cardiovascular risk gain little or nothing from cutting saturated fat over 5 years. An older meta-regression of 224 diet studies predicted about 5% lower total and LDL cholesterol from staying under 300 mg cholesterol a day and under 10% of energy from saturated fat. That is a model prediction from studies that were not all randomized, and one cup of chitterlings already passes 300 mg. Large diet studies have mostly not counted this food at all: a survey of 1699 adults in the Lower Mississippi Delta found chitterlings among regional foods missing from the questionnaires used nationally.

Sources

1. chtl-r1-01 · USDA FNDDS, dataset
   Chitterlings (FNDDS 25170210, FDC 2706163, WWEIA Liver and organ meats): 1 cup = 125 g; 1 oz yields = 20 g; Quantity not specified = 85 g; per 100 g: Energy 231 kcal; Protein 12.39 g; Total lipid (fat) 20.16 g; Fatty acids, total saturated 9.444 g; Cholesterol 275 mg; Sodium 325 mg; Selenium 26.8 µg; Zinc 1.84 mg; per 1 cup: cholesterol 343.8 mg
   USDA FNDDS 2021-2023, food code 25170210 (FDC 2706163) · checked 2026-09-29
2. chtl-r1-07 · nutrition survey analysis
   We ranked food sources of energy, macronutrients, vitamins and minerals, and examined portion size distributions for 842 white and 857 African American residents aged 19 years and older, using 24-hour dietary intake recall data from a telephone survey of 36 LMD counties...Regional foods not on nationally used FFQs included grits, turnip greens, okra, ham hocks, chitterlings, crawfish, catfish, cracklings, jambalaya, potato logs, chicken and dumplings, and sweet potato pie.
   Public Health Nutr, 2005 · checked 2026-09-29
3. chtl-r1-03 · outbreak investigation
   Of 13 samples of frozen chitterlings purchased in Tennessee in February, 2 were positive for Y. intermedia; 5 were positive for Salmonella...Because chitterlings are traditionally thoroughly boiled, the final cooked product is likely not to be bacterially contaminated. The preparation process, however, involves substantial handling of large amounts of potentially contaminated product, and the risk for exposure of infants to this process is high.
   Emerg Infect Dis, 2003 · checked 2026-09-29
4. chtl-r1-08 · meta-analysis
   Dietary cholesterol statistically significantly increased both serum total cholesterol (17 trials; net change: 11.2 mg/dL; 95% CI: 6.4, 15.9) and low-density lipoprotein (LDL) cholesterol (14 trials; net change: 6.7 mg/dL; 95% CI: 1.7, 11.7 mg/dL). Increases in LDL cholesterol were no longer statistically significant when intervention doses exceeded 900 mg/d.
   Am J Clin Nutr, 2015 · checked 2026-09-29
5. chtl-r1-09 · meta-analysis of RCTs
   There were 17 eligible trials (66 337 participants)...The effects were more pronounced when replacing saturated fat with polyunsaturated fat for nonfatal MI (RR, 0.75 [CI, 0.58 to 0.99]; P for interaction = 0.05; moderate credibility of subgroup effect based on Instrument to assess the Credibility of Effect Modification Analyses assessments)...CONCLUSION: For persons at low cardiovascular risk, reducing or modifying saturated fat intake has little or no benefit over a period of 5 years.
   Ann Intern Med, 2026 · checked 2026-09-29
6. chtl-r1-10 · meta-analysis of intervention studies
   data from 224 published studies on 8143 subjects in 366 independent groups including 878 diet-blood lipid comparisons were subjected to weighted multiple-regression analysis...Predictions indicated that compliance with current dietary recommendations (30% of energy from fat, < 10% from saturated fat, and < 300 mg cholesterol/d) will reduce plasma total and low-density-lipoprotein-cholesterol concentrations by approximately 5% compared with amounts associated with the average American diet.
   Am J Clin Nutr, 1997 · checked 2026-09-29
7. chtl-r1-02 · case-control study
   Chitterlings had been prepared in the homes of all case-patients from November 1, 2001, to January 31, 2002, compared with 35% of controls (p<0.001)...These exposures included the infant roaming freely in a walker in the room where chitterlings were being cleaned, chitterling juices splashing on clean dishes or a baby’s bottle, washing bottles in a sink that was not thoroughly cleaned, and feeding or handing a pacifier to an infant during cleaning or preparation of chitterlings.
   Emerg Infect Dis, 2003 · checked 2026-09-29
8. chtl-r1-04 · case report
   In December 1998, enteritis necroticans developed in a 12-year-old boy with poorly controlled diabetes mellitus after he consumed pig intestines (chitterlings)...At laparotomy, extensive jejunal necrosis required bowel resection, jejunostomy, and ileostomy...CONCLUSIONS: The preparation or consumption of chitterlings by diabetic patients and other chronically ill persons can result in potentially life-threatening infectious complications.
   N Engl J Med, 2000 · checked 2026-09-29
9. chtl-r1-05 · case report
   A 10-year-old black girl with sickle cell disease receiving chelation therapy for iron overload resulting from chronic transfusion therapy was admitted with acute abdominal pain and fever...Household exposure to raw pork intestines (chitterlings) was the presumed source of the infection...Deferoxamine therapy should be withheld in iron-overloaded patients presenting with such symptoms because deferoxamine and iron overload constitute independent risk factors for Yersinia infection.
   Am J Pediatr Hematol Oncol, 1994 · checked 2026-09-29
10. chtl-r1-06 · case report
    It is most commonly reported in infants and children due to cross-contamination of their feeds and pacifiers by people handling pork products, especially while cooking chitterlings. Necrotizing enterocolitis has been described in infants following YE infections. Adults who are immunocompromised or in an iron-overload state can develop sepsis with YE infection, which has a high fatality rate.
    Cureus, 2022 · checked 2026-09-29