Liver and liverwurst: so much vitamin A that EFSA says once a month, and none in pregnancy

In a randomized trial in 150 children aged 2 to 3 in rural Burkina Faso, 15 weeks of promoting liver and mango raised serum retinol by 26% and 30% in the two arms. There was no control group, and liver and mango were never separated. In non-pregnant women, one liver meal with up to 120,000 IU of vitamin A raised exposure to two 13-cis retinoic acid forms three- to five-fold over 24 hours, a blood marker from a study whose abstract gives no sample size. By UK composition tables, 3.5 oz (100 g) of raw calf liver carries about 18,800 micrograms of retinol, raw chicken liver 9,700 and liver sausage 2,600, single values with the sausage made to a British recipe. EFSA sets the adult upper limit for preformed vitamin A at 3,000 micrograms a day and says Europeans stay under it if liver and offal are eaten once a month or less. In the UK national diet survey, the 25 women aged 16 to 49 who ate liver got about 3,500 micrograms a day from it on average. So few eaters make that figure uncertain, and setting it against the EFSA limit is our comparison. EFSA advises women who are pregnant or planning a pregnancy not to eat liver products at all.

How much is actually in it

• Per 100 g, raw calf liver carries about 18,800 micrograms of retinol and liver sausage about 2,600, so the sausage holds roughly a seventh of the vitamin A of plain liver. — CoFID entries: Liver, calf, raw (18-409); Liver, chicken, raw (18-411); Liver, ox, stewed (18-416); Liver sausage (19-106) (n = 4 foods) Evidence E source
  Retinol per 3.5 oz (100 g): calf raw 18800 ug; chicken raw 9700 ug; ox stewed 17300 ug (retinol equivalent 17560); liver sausage 2600 ug
• Liver is dense in iron and vitamin B12, and liver sausage keeps a smaller share of both while adding about 810 mg of sodium per 3.5 oz (100 g). — CoFID entries: Liver, calf, raw; Liver, chicken, raw; Liver, ox, stewed; Liver sausage (n = 4 foods) Evidence E source
  Per 100 g iron / B12: calf raw 11.5 mg / 68 ug; chicken raw 9.2 mg / 35 ug; ox stewed 7.8 mg / 110 ug; liver sausage 6.0 mg / 10 ug; liver sausage sodium 810 mg, fat 16.7 g; chicken liver folate 995 ug

What a real portion looks like

• A typical slice of beef liver weighs 3 oz (85 g), one chicken liver about 22 g, and a slice of liverwurst 28 g, with 56 g on a regular sandwich. — FNDDS portion weights: Liver, beef (25110140); Liver, chicken (25110450); Liverwurst (25230560) Evidence E source
  Beef liver: 1 slice 85 g, 1 cup 125 g; chicken liver: 1 liver 22 g, 1 cup 140 g; liverwurst: 1 slice 28 g, regular sandwich 56 g, large sandwich 84 g
• In a survey of 2,864 preschool children in South Africa's Northern Cape, 86% ate liver, typically once a month, and 2.1-2.6 oz (60-75 g) of liver a month meets a preschool child's vitamin A need. — mothers of 2,864 children aged 2-5 years, all districts of Northern Cape (n = 2864) Evidence C source
  86% ate liver; median 1.0 time per month; 60-75 g per month meets requirement
• Among the few UK women aged 16-49 who ate liver in the national diet survey, liver alone supplied on average about 3,500 micrograms of vitamin A a day, and 7,500 at the 97.5th percentile, above the 3,000 microgram upper limit. — women aged 16-49, UK NDNS years 1-8, liver consumers (with recipes) (n = 25 consumers) Evidence E source
  Vitamin A from liver: mean 3500 ug/day (50 ug/kg bw), 97.5th percentile 7500 ug/day (97 ug/kg bw)

What your body absorbs

• In non-pregnant women, a single liver meal with up to 120,000 IU of vitamin A raised exposure to 13-cis and 13-cis-4-oxo retinoic acid three- to five-fold over 24 hours. — non-pregnant female volunteers, single liver meal with up to 120,000 IU vitamin A Evidence B source
  AUC24h of 13-cis and 13-cis-4-oxo retinoic acid up 3-5 fold; all-trans retinoic acid exposure unchanged despite a two-fold peak
• According to NIH, liver is among the richest sources of preformed vitamin A, and the body may absorb 75% to 100% of retinol from foods. — general population Evidence E source
  Retinol absorption 75-100% versus 10-30% for beta-carotene

What cooking and storage change

• By the USDA factors for simmered beef liver, about 60% of iron and vitamin B12 and 65% of folate remain after cooking. — USDA retention factors, Beef Products, LIVER,SIMMERED,WO/DRIPPINGS Evidence E source
  Retained: iron 60%, vitamin B12 60%, folate 65%, riboflavin 55%, zinc 90%, choline 100%
• In a hotel outbreak in England, chicken liver pate carried a crude relative risk of 12.95 for campylobacteriosis. — guests of one Christmas set-menu meal, 19 cases (n = 19) Evidence C source
  Crude relative risk 12.95, P<0.001, with dose-response

What it does to your health

• In 150 children aged 2-3 years in Burkina Faso, promoting liver and mango for 15 weeks raised serum retinol by 26% to 30%. — 150 children aged 2-3 years, rural Burkina Faso, 15 weeks (n = 150) Evidence B source
  Vitamin A intake from liver rose from 12.7 to 155.3 ug RAE (PA$$) and from 21.6 to 135.3 ug RAE (PA); serum retinol +26% and +30%, P<0.001
• In a trial in 240 pregnant women in South China, iron-rich foods including pork liver three days a week lowered iron deficiency in late pregnancy to 9.0% versus 22.8% in controls. — 240 pregnant women at 11-13 weeks without iron-deficiency anemia, 170 analyzed, until delivery (n = 240) Evidence B source
  Iron deficiency (SF <12 ng/mL) 9.0% vs 22.8%, P=0.022 (IRF-40); no effect on anemia or hemoglobin

Safety, limits and interactions

• EFSA keeps the upper limit for preformed vitamin A at 3,000 micrograms a day for adults, says intakes stay below it if liver and offal are eaten once a month or less, and advises women planning pregnancy or pregnant not to eat liver products. — European adults, including women of child-bearing age and pregnant women Evidence E source
  UL 3000 ug RE/day adults; liver, offal and products no more than once per month; no liver products before and during pregnancy
• According to NIH, total intakes of preformed vitamin A above the upper limit can cause congenital birth defects. — women who are or might be pregnant Evidence E source
  Teratogenic above the UL; experts advise against supplements above 3,000 mcg RAE a day in pregnancy
• In 94 South African preschool children with vitamin A excess from liver, fortified food and supplements, higher liver vitamin A reserves were linked to lower height- and weight-for-age. — 94 children aged 36-60 months, Northern Cape, South Africa (n = 94) Evidence C source
  Liver vitamin A reserves explained 6-10% of growth z-score variation before and 14-19% after a 200,000 IU dose
• In Japan, banning raw beef liver in restaurants from 2012 was not followed by a measurable drop in EHEC infections. — national notifiable disease data, Japan, 2008-2017 Evidence C source
  No significant change in intercept or trend for asymptomatic or symptomatic EHEC
• UK Government advice, as restated by the Committee on Toxicity in 2022, is that pregnant women and women thinking about having a baby should not eat liver or liver products such as pate, unless advised by a GP. — pregnant women and women planning pregnancy, UK Evidence E source
  Avoid liver, liver products such as pate, and vitamin A supplements including fish liver oil
• NIH names liver as one of the richest sources of preformed vitamin A. Its upper limit counts food and supplements together. It is 600 mcg a day up to age 3, 900 mcg at 4 to 8, 1,700 mcg at 9 to 13, 2,800 mcg at 14 to 18 and 3,000 mcg for adults. Intakes above it can cause birth defects. — children by age band, adults, and women who are or might be pregnant or are lactating Evidence E source
  UL for preformed vitamin A from food plus supplements: 600 mcg to age 3, 900 mcg at 4-8, 1,700 mcg at 9-13, 2,800 mcg at 14-18, 3,000 mcg from 19 (pregnancy and lactation included); intakes above the UL can cause birth defects of the eye, skull, lungs and heart

The bottom line

Liverwurst keeps less of everything. Per 100 g it has 6.0 mg of iron and 10 micrograms of B12, against 11.5 mg and 68 micrograms in raw calf liver, and it adds 810 mg of sodium and 16.7 g of fat. In US survey coding a slice of beef liver weighs 3 oz (85 g), one chicken liver 22 g, and a slice of liverwurst 28 g. Simmering beef liver keeps about 60% of its iron and B12 and 65% of its folate, by USDA factors from 1975 that do not cover liverwurst. NIH names liver among the richest sources of preformed vitamin A and says the body may absorb 75% to 100% of retinol from food, against 10% to 30% of beta-carotene. Pregnancy is where the caution is firmest. EFSA advises women who are planning a pregnancy or are pregnant not to eat liver products, and NIH says total preformed vitamin A above the upper limit can cause birth defects. The same NIH fact sheet names some retinoid medicines, such as isotretinoin for severe acne, as a cause of birth defects too, so for anyone who takes one, or takes vitamin A supplements, liver is a question for the person treating them. UK Government advice, restated by the Committee on Toxicity in 2022, says the same and names pâté, along with vitamin A supplements including fish liver oil, unless a GP advises otherwise. Both name liver products, not only plain liver, so the lower vitamin A figure for liverwurst does not exempt it. A separate trial in 240 pregnant women in South China, 170 of them analyzed, gave iron-rich foods including pork liver three days a week. Iron deficiency in late pregnancy fell to 9.0% against 22.8%, with no effect on anemia or hemoglobin, and liver was one of four foods. We have no data from that trial on vitamin A intake or birth defects, so it does not answer the EFSA caution. Children can get too much as well. In 94 South African preschool children with vitamin A excess from liver, fortified food and supplements, higher liver stores went with lower height and weight for age, an association in which liver was not separated from the rest. In the same province 86% of preschool children ate liver, typically once a month, and 60 to 75 g a month meets a preschool child's need. No card on this page gives the upper limit for children, so the adult figure above cannot be applied to them. Liver dishes have also carried bacteria. In one hotel outbreak in England, chicken liver pâté carried a crude relative risk of 12.95 for Campylobacter. No card on this page gives a safe cooking temperature for chicken liver or pâté. Japan banned raw beef liver in restaurants in 2012, and national EHEC infection rates showed no measurable drop afterward. That is a count across the whole country, and it does not show that raw liver is safe to eat.

Sources

1. lvlw-r4-01 · reference dataset
   CoFID 18-409 Liver, calf, raw — Retinol 18800 µg || CoFID 18-411 Liver, chicken, raw — Retinol 9700 µg || CoFID 18-416 Liver, ox, stewed — Retinol 17300 µg · Retinol Equivalent 17560 µg || CoFID 19-106 Liver sausage — Retinol 2600 µg
   CoFID 2021, Public Health England / OGL v3.0 · checked 2026-09-29
2. lvlw-r4-02 · reference dataset
   CoFID 18-409 Liver, calf, raw — Iron 11.50 mg · Vitamin B12 68.0 µg || CoFID 18-411 Liver, chicken, raw — Iron 9.20 mg · Vitamin B12 35.0 µg · Folate 995 µg || CoFID 18-416 Liver, ox, stewed — Iron 7.80 mg · Vitamin B12 110.0 µg || CoFID 19-106 Liver sausage — Iron 6.00 mg · Vitamin B12 10.0 µg · Sodium 810 mg · Fat 16.7 g
   CoFID 2021, Public Health England / OGL v3.0 · checked 2026-09-29
3. lvlw-r4-04 · reference dataset
   FNDDS 25110140 Liver, beef — 1 slice, any size 85 g · 1 cup 125 g || FNDDS 25110450 Liver, chicken — 1 liver 22 g · 1 cup 140 g || FNDDS 25230560 Liverwurst — 1 slice, NFS 28 g · Guideline amount on regular sandwich 56 g · Guideline amount on large sandwich 84 g
   USDA FNDDS 2021-2023 via FoodData Central, fdc_id 2706153, 2706154 and 2706213 · checked 2026-09-29
4. lvlw-r4-12 · cross-sectional survey
   Only 60-75 g of liver per month is needed to meet the vitamin A requirement of preschool children.
   Matern Child Nutr, 2020 · checked 2026-09-29
5. lvlw-ws10-16 · exposure assessment
   Liver and liver products in the diet constitute a major source of dietary pre-formed RE. || Table 3. Chronic exposure of Vitamin A from Liver (with recipes) in women aged 16 -49 — Consumers 25 · Mean 3500 µg/person/day · 97.5th percentile 7500 µg/person/day · Mean 50 µg/kg bw/day · 97.5th percentile 97 µg/kg bw/day
   Committee on Toxicity (COT), Statement on the effects of excess Vitamin A on maternal health, 2022, para 111 and Table 3 · checked 2026-09-29
6. lvlw-r4-05 · randomized pharmacokinetic trial
   Concentrations of 13-cis and 13-cis-4-oxo RA increased several-fold after a liver meal, and exposure (AUC24h) increased three- to five-fold.
   Int J Vitam Nutr Res, 2005 · checked 2026-09-29
7. lvlw-r4-08 · agency fact sheet
   Concentrations of preformed vitamin A are highest in liver, fish, eggs, and dairy products [1]. ... The body might absorb up to 75% to 100% of retinol and, in most cases, 10% to 30% of beta-carotene from foods [17,18].
   NIH Office of Dietary Supplements, Vitamin A Fact Sheet for Health Professionals · checked 2026-09-29
8. lvlw-r4-03 · reference dataset
   USDA-RETN-R6:1152 LIVER,SIMMERED,WO/DRIPPINGS — iron_mg 60% · vitamin_b12_ug 60% · folate_total_ug 65% · riboflavin_mg 55% · zinc_mg 90% · choline_mg 100%
   USDA Table of Nutrient Retention Factors, Release 6 (2007) · checked 2026-09-29
9. lvlw-r4-13 · retrospective cohort
   Chicken liver pâté was the food item most strongly associated with illness (P < 0.001) with a corresponding high crude relative risk (12.95).
   Epidemiol Infect, 2020 · checked 2026-09-29
10. lvlw-r4-09 · randomized trial
    VA intake from liver increased significantly (P < 0.001) from 12.7 +/- 23.5 to 155.3 +/- 56.3 microg retinol activity equivalents (RAE) in PA$$ and from 21.6 +/- 29.7 to 135.3 +/- 44.9 microg RAE in PA. Changes in VA intake from liver were significantly higher (P = 0.004) in PA$$ compared with PA. Mean serum retinol concentration increased significantly by 26% (P < 0.001) in PA$$ and 30% (P < 0.001) in PA.
    Public Health Nutr, 2006 · checked 2026-09-29
11. lvlw-r4-10 · randomized controlled trial
    Specifically, IRF-40 showed a lower ID (SF <12 ng/mL) rate than control (9.0% compared with 22.8%, P = 0.022).
    J Nutr, 2022 · checked 2026-09-29
12. lvlw-r4-06 · agency scientific opinion
    Based on available intake data, European populations are unlikely to exceed the UL for preformed vitamin A if consumption of liver, offal and products thereof is limited to once per month or less. Women who are planning to become pregnant or who are pregnant are advised not to consume liver products.
    EFSA NDA Panel, Scientific opinion on the tolerable upper intake level for preformed vitamin A and beta-carotene, 2024 · checked 2026-09-29
13. lvlw-r4-07 · agency fact sheet
    Total intakes of preformed vitamin A that exceed the UL as well as some retinoid medications used as topical therapies (such as isotretinoin, used to treat severe acne, and etretinate, a treatment for severe psoriasis) can cause congenital birth defects [1].
    NIH Office of Dietary Supplements, Vitamin A Fact Sheet for Health Professionals · checked 2026-09-29
14. lvlw-r4-11 · clinical study
    Excessive TLRs due to dietary VA intake and VAS are associated with lower anthropometric measures and bone resorption decreased after supplementation.
    Am J Clin Nutr, 2022 · checked 2026-09-29
15. lvlw-r4-14 · interrupted time series
    We did not find a statistically significant reduction in the overall incidence rates of both asymptomatic and symptomatic EHEC infections in Japan after implementing measures, including a ban on serving raw beef liver dishes in the restaurant industry.
    BMC Infect Dis, 2019 · checked 2026-09-29
16. lvlw-ws10-15 · agency statement
    UK Government dietary advice, as given on the NHS website, recommends that pregnant women, or women thinking about having a baby, should not consume liver or liver products such as pate, or supplements that contain vitamin A, including fish liver oil, unless advised by a GP, to avoid potential harm to the unborn child.
    Committee on Toxicity (COT), Statement on the effects of excess Vitamin A on maternal health, 21 September 2022, para 6 · checked 2026-09-29
17. sf-vita-r4-3 · agency advice
    Concentrations of preformed vitamin A are highest in liver, fish, eggs, and dairy products [1]. ... The FNB has established ULs for preformed vitamin A that apply to both food and supplement intakes [5]. The FNB based these ULs on the amounts associated with an increased risk of liver abnormalities in men and women, teratogenic effects, and several toxic effects in infants and children. ... Birth to 12 months 600 mcg 600 mcg 1–3 years 600 mcg 600 mcg 4–8 years 900 mcg 900 mcg 9–13 years 1,700 mcg 1,700 mcg 14–18 years 2,800 mcg 2,800 mcg 2,800 mcg 2,800 mcg 19+ years 3,000 mcg 3,000 mcg 3,000 mcg 3,000 mcg ... Total intakes of preformed vitamin A that exceed the UL as well as some retinoid medications used as topical therapies (such as isotretinoin, used to treat severe acne, and etretinate, a treatment for severe psoriasis) can cause congenital birth defects [1]. These birth defects can include malformations of the eye, skull, lungs, and heart [14]. Experts advise women who are or might be pregnant and those who are lactating not to take high doses (more than 3,000 mcg RAE [10,000 IU] daily) of vitamin A supplements [1].
    NIH Office of Dietary Supplements, Vitamin A and Carotenoids Fact Sheet for Health Professionals · checked 2026-10-08