Liver sausage: a vitamin A food with a pregnancy question

In a randomized trial in 35 women given single doses of 3, 7.5 or 15 mg of vitamin A, liver paste was absorbed as well as a supplement and left higher blood levels of retinoic acid metabolites. The researchers used those metabolites as a stand-in for birth defect risk. Liver sausage is a vitamin A food first, and how much it carries depends on where it was made. US pork liverwurst is listed at 8308 mcg of vitamin A per 3.5 oz (100 g) and the UK table gives 2600 mcg for liver sausage, each a single record with no sample spread. The US upper limit for preformed vitamin A counts food as well as supplements, and it rests on liver abnormalities, birth defects and toxic effects in infants and children. By that fact sheet, a 3.5 oz (100 g) serving of the US product already sits above the adult limit.

The numbers, per 3.5 oz (100 g)

How much is actually in it

• US pork liverwurst lists 8308 ug vitamin A and 13.46 ug vitamin B12 per 3.5 oz (100 g), while the UK table gives 2600 ug and 10 ug for liver sausage. — USDA SR Legacy record and CoFID 2021 record (n = 2 records) Evidence E source
  Vitamin A 8308 (USDA) vs 2600 ug/100 g (CoFID), 69% apart; B12 13.46 vs 10.0 ug, 26% apart; USDA selenium 58 ug

What a real portion looks like

• UK liver sausage carries 226 calories, 16.7 g fat, 6 mg iron and 810 mg sodium per 3.5 oz (100 g). — CoFID 2021 record 19-106 (n = 1 record) Evidence E source
  Per 100 g: energy 226 calories, fat 16.7 g, protein 13.4 g, iron 6.00 mg, sodium 810 mg, retinol 2600 ug

What your body absorbs

• In 35 women given 3 to 15 mg vitamin A, liver paste was absorbed as well as a supplement but produced more retinoic acid metabolites in blood. — Women (n = 35; 19-47 y of age), single doses of 3.0, 7.5 or 15 mg vitamin A (n = 35) Evidence B source
  Retinyl ester AUC equal by source; 13-cis-RA and 13-cis-4-oxo-RA significantly higher after liver paste, especially at higher doses
• After a liver meal with up to 120,000 IU vitamin A, exposure to 13-cis retinoic acid metabolites in women rose three- to five-fold over 24 hours. — non-pregnant female volunteers, single liver meal up to 120,000 IU vitamin A Evidence B source
  13-cis and 13-cis-4-oxo RA AUC24h up 3-5 fold; all-trans RA exposure unchanged despite twofold peak

What cooking and storage change

• In three French families, recent hepatitis E infection was found in 7 of 13 people who ate raw figatellu pig liver sausage and 0 of 5 who did not. — 3 patients with autochthonous hepatitis E and 15 family members, France (n = 18) Evidence C source
  7/13 exposed vs 0/5 unexposed (P = 0.041); HEV RNA in 7 of 12 supermarket figatelli
• Hepatitis E virus RNA was found in 7 of 37 ready-to-eat pork liver sausages on Swiss retail shelves. — 90 ready-to-eat meat products from Swiss retail, incl. 37 liver sausages (n = 37) Evidence C source
  HEV RNA in 18.9% of liver sausages vs 5.7% of raw meat sausages; up to 5.54 log10 copies/g

What it does to your health

• In 240 pregnant women in South China, iron-rich foods including pork liver three days a week cut late-pregnancy iron-deficiency anemia to 1.9% from 8.9%. — 240 pregnant women at 11-13 weeks without iron-deficiency anemia, South China; 170 analyzed (n = 240) Evidence B source
  IDA 1.9% vs 8.9% (IRF-40 vs control, P = 0.045); no effect on anemia or hemoglobin

Safety, limits and interactions

• A 2024 US Listeria outbreak traced to deli-sliced meats including Boar's Head liverwurst sickened 61 people in 19 states and killed ten. — 61 people in 19 states, 2024 (n = 61) Evidence E source
  61 infected, 60 hospitalized, 10 deaths; about 6 in 10 cases who were asked reported eating deli-sliced liverwurst
• Among 313 blood donors in central Italy, eating raw dried pig liver sausage was the only independent predictor of hepatitis E infection, PRR 2.14. — 313 blood donors, central Italy, 2014 (n = 313) Evidence C source
  Adjusted prevalence rate ratio 2.14 (95% CI 1.23 to 3.74); overall anti-HEV IgG 49%
• Two cases of foodborne botulism followed eating commercially canned German liver sausage, one needing 15 days of breathing support. — two adults, Switzerland (n = 2) Evidence C source
  One respiratory paralysis for 15 days, one cranial nerve weakness; both recovered

Who this works differently for

• The US upper limit for preformed vitamin A covers food as well as supplements and rests on liver damage and birth defect risk. — adults, pregnant women, infants and children Evidence E source
  UL applies to preformed vitamin A from food and supplements
• CDC advises pregnant women, adults 65 and older and people with a weakened immune system to avoid refrigerated pâté or meat spreads, such as spreadable liver sausage, and to choose shelf-stable ones in sealed containers instead. — people at higher risk of listeriosis: pregnant women, adults 65 and older, people with a weakened immune system Evidence E source
  Avoid refrigerated pate or meat spreads, choose shelf-stable pate or spreads in sealed airtight containers
• Liver sausage is made with liver, which NIH names as one of the richest sources of preformed vitamin A. The upper limit, food and supplements combined, is 3,000 mcg a day for adults and 600 mcg up to age 3, 900 mcg at 4 to 8 and 1,700 mcg at 9 to 13. 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

What is still unknown

• In 311 infants exposed in early pregnancy to 10,000 IU or more of vitamin A a day, three had a major malformation, with no clear rise over controls. — 311 infants exposed to a median daily dose of vitamin A of 50,000 IU per day in the first 9 weeks (n = 311) Evidence C source
  Rate ratio 0.28 (95% CI 0.06 to 1.23) and 0.50 (0.14 to 1.76) vs two control groups; study could exclude only risks above 2.76 times baseline

The bottom line

Per 100 g, UK liver sausage carries 226 calories, 16.7 g fat, 13.4 g protein, 6 mg iron and 810 mg sodium. We found no portion data, so per-slice figures cannot be given. In a randomized trial in 240 pregnant women in South China, eating iron-rich foods including pork liver three days a week brought late-pregnancy iron-deficiency anemia down to 1.9% from 8.9%. Pork liver was one of four foods there, and liver sausage itself was not tested. We have no data from that trial on vitamin A intake or birth defects, so it does not answer the pregnancy caution below. In pregnancy the concern is vitamin A. After a single liver meal with up to 120,000 IU of vitamin A, non-pregnant women showed three- to five-fold more exposure to 13-cis retinoic acid metabolites over 24 hours. A prospective study of 311 infants exposed to high vitamin A in early pregnancy found no evidence of more major malformations. That study could only rule out a risk more than 2.76 times the baseline of 1.91%, and the exposure was mostly supplements. Who should take care. Pregnant women face the vitamin A question above. The US upper limit for preformed vitamin A counts food, covers pregnancy, and was set partly on the risk of birth defects, so a small study that could not rule out a modest risk is no reassurance. Infants and children fall under the same limit, and no card on this page gives the figure for them. Infection is a further risk. The CDC traced a 2024 US Listeria outbreak to meats sliced at deli counters, including Boar's Head liverwurst: 61 people in 19 states were infected, 60 were hospitalized and 10 died. No card on this page names the groups most at risk from Listeria or the advice for them. Raw pig liver sausage carries hepatitis E, and no card here says how to cook it to make it safe. In three French families, recent hepatitis E infection was found in 7 of 13 people who ate raw figatellu and in 0 of 5 who did not, a very small sample. Among 313 blood donors in central Italy, eating raw dried pig liver sausage was the only independent predictor of infection, with a prevalence rate ratio of 2.14 (95% CI 1.23 to 3.74), from a cross-sectional survey. Hepatitis E RNA turned up in 7 of 37 ready-to-eat liver sausages on Swiss shelves, though RNA does not prove live virus. A 1984 Swiss report describes two cases of botulism after commercially canned German liver sausage, one of them needing 15 days of breathing support.

Sources

1. lvsg-r6-01 · reference dataset
   Liver sausage, liverwurst, pork (FDC 173870, SR Legacy): vitamin A 8308 ug/100 g, vitamin B12 13.46 ug, selenium 58 ug · CoFID 2021 19-106 Liver sausage: Retinol 2600 ug, Vitamin B12 10.0 ug
   USDA FoodData Central, SR Legacy, FDC 173870; CoFID 2021 19-106 · checked 2026-10-02
2. lvsg-r6-02 · reference dataset
   CoFID 2021 19-106 Liver sausage: Energy (kcal) 226 · Fat (g) 16.7 · Protein (g) 13.4 · Iron (mg) 6.00 · Sodium (mg) 810 · Retinol (ug) 2600
   CoFID 2021, Public Health England, OGL v3.0, code 19-106 · checked 2026-10-02
3. lvsg-r6-03 · randomized controlled trial
   Women (n = 35; 19-47 y of age) consumed 3.0, 7.5 or 15 mg vitamin A as liver paste or as a vitamin A supplement with a test meal in a randomized design, with a combined crossover (two sources) and parallel approach (three dosages). ... In conclusion, the bioavailability of vitamin A from single doses of liver paste and a vitamin A supplement does not differ, but the plasma concentrations of RA metabolites are higher after intake of liver paste.
   J Nutr, 2001 · checked 2026-10-02
4. lvsg-r6-04 · randomized controlled 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 2026-10-02
5. lvsg-r6-09 · case-control study
   Acute or recent HEV infection, defined by detection of anti-HEV immunoglobulin M antibodies and/or HEV RNA, was observed in 7 of 13 individuals who ate raw figatellu and 0 of 5 individuals who did not eat raw figatellu (P=.041).
   J Infect Dis, 2010 · checked 2026-10-02
6. lvsg-r6-11 · food survey
   In the screening programme, HEV-RNA was detected in 10 of total 90 (11.1%) meat products, 7 of 37 (18.9%) liver sausages, and 3 of 53 (5.7%) raw meat sausages.
   Food Environ Virol, 2018 · checked 2026-10-02
7. lvsg-r6-13 · randomized controlled trial
   For IDA by definition 1, the incidence in IRF-40 was lower than that in control (1.9% compared with 8.9%, P = 0.045).
   J Nutr, 2022 · checked 2026-10-02
8. lvsg-r6-08 · outbreak investigation
   Epidemiologic, laboratory, and traceback data showed that meats sliced at deli counters, including Boar's Head brand liverwurst, were contaminated with Listeria and made people sick.
   US CDC, Listeria Outbreak Linked to Meats Sliced at Delis, 2024 · checked 2026-10-02
9. lvsg-r6-10 · cross-sectional study
   Eating raw dried pig-liver sausage was the only independent predictor of HEV infection (adjusted prevalence rate ratio = 2.14; 95% confidence interval: 1.23-3.74).
   Euro Surveill, 2016 · checked 2026-10-02
10. lvsg-r6-12 · case report
    Two cases of food-borne botulism following consumption of commercially canned German-made liver sausage are presented.
    Schweiz Med Wochenschr, 1984 · checked 2026-10-02
11. lvsg-r6-06 · agency fact sheet
    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.
    NIH Office of Dietary Supplements, Vitamin A and Carotenoids Fact Sheet for Health Professionals · checked 2026-10-02
12. sf-lis-r1-1 · agency advice
    You may be at higher risk if you are in one of the following groups: Women who are pregnant ... People who are 65 years or older ... People who have a weakened immune system ... Refrigerated pâté or meat spreads ... Pâté or meat spreads in sealed, airtight containers that don't need to be kept refrigerated before opening
    US CDC, Preventing Listeria Infection · checked 2026-10-08
13. sf-vita-r4-4 · 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
14. lvsg-r6-05 · prospective controlled cohort
    The studied sample did not provide evidence for an increased risk of major malformations, associated with "high" vitamin A intake during the organogenetic period, higher than 2.76 above the control reference risk of 1.91% (power 80%, alpha 0.10).
    Teratology, 1999 · checked 2026-10-02