U.S. Dietary Guideline Changes May Conflict With Liver Health Findings

Key Clinical Summary

• Analysis of 10,944 U.S. adults from NHANES 2017–2023 found that several individual dietary components were independently associated with steatotic liver disease (SLD), fibrosis, and cirrhosis based on vibration-controlled transient elastography (VCTE).

• Higher intake of total fruit, whole fruit, vegetables, greens and beans, whole grains, and seafood/plant protein was associated with lower odds of SLD and fibrosis, whereas greater intake of red/processed meats, sodium, total protein, saturated fat, and added sugars was associated with higher disease prevalence.

• Findings suggest that some 2025–2030 Dietary Guidelines for Americans (DGA-2025) recommendations, particularly increased emphasis on total protein and reduced attention to protein sources and alcohol guidance, may not fully align with dietary factors associated with liver health.

The 2025–2030 Dietary Guidelines for Americans (DGA-2025) introduced notable revisions to U.S. nutrition recommendations, including greater emphasis on total protein intake and removal of previous alcohol guidance. A cross-sectional analysis of nationally representative NHANES data suggests that several of these changes may not reflect dietary components most strongly associated with steatotic liver disease (SLD), fibrosis, and cirrhosis.

Study Findings

Investigators analyzed dietary and liver assessment data from 10,944 U.S. adults participating in the National Health and Nutrition Examination Survey (NHANES) between 2017 and 2023. Participants completed 24-hour dietary recall questionnaires and underwent vibration-controlled transient elastography (VCTE) to assess hepatic steatosis and fibrosis.

Dietary exposures were evaluated using two complementary approaches: component scores from the Healthy Eating Index-2020 (HEI-2020) and energy-adjusted z-score models reflecting food groups emphasized in the DGA-2025. Researchers also developed an alcohol adherence score based on the alcohol consumption thresholds included in the previous 2020 Dietary Guidelines for Americans.

Multivariable logistic regression and stepwise analyses adjusted for sociodemographic characteristics, obesity, diabetes, caffeine intake, and the complex NHANES survey design identified several dietary components consistently associated with liver outcomes.

Higher consumption of total fruit, whole fruit, vegetables, greens and beans, whole grains, and seafood/plant protein was associated with lower odds of SLD and fibrosis. Conversely, higher intake of red and processed meats, sodium, total protein, saturated fat, and added sugars was associated with greater prevalence of SLD and fibrosis.

Alcohol adherence scores derived from prior DGA-2020 recommendations were strongly protective across all liver outcomes. In stepwise models, greens and beans, seafood and plant protein, saturated fat, and alcohol use remained independent predictors of liver disease outcomes.

The investigators also observed that dietary components emphasized in the DGA-2025, including total protein and red meat, were associated with greater fibrosis risk, while several dietary factors associated with favorable liver outcomes—such as greens and beans and seafood/plant protein—were not emphasized in the updated guidelines.

Clinical Implications

The findings highlight the importance of evaluating individual dietary components rather than broad dietary categories when developing nutrition recommendations for liver health. The results suggest that the source of dietary protein may be more clinically relevant than total protein intake alone.

For clinicians caring for patients with SLD or those at risk for progressive liver disease, the analysis supports dietary patterns characterized by higher intake of fruits, vegetables, whole grains, and seafood or plant-based protein sources while limiting saturated fat, sodium, added sugars, and red or processed meats.

The study also raises questions about the omission of prior alcohol guidance from the DGA-2025. Although the analysis found alcohol adherence scores based on previous guideline thresholds to be protective across liver outcomes, the cross-sectional design precludes causal inference, and the findings should be interpreted within the context of the study methodology.

Expert Commentary

The investigators concluded that both the HEI-2020 and z-score dietary models identified multiple dietary components independently associated with SLD and fibrosis. They emphasized that the findings underscore the need for component-level nuance, particularly regarding protein sources and alcohol intake, when developing dietary guidance intended to support liver health.

The authors further noted that several protective dietary components identified in the analysis were not emphasized in the 2025–2030 Dietary Guidelines for Americans, whereas some newly emphasized components were associated with increased fibrosis risk in this study.

The findings suggest that dietary recommendations for liver health may benefit from greater emphasis on specific food sources rather than total nutrient intake alone. Additional research is needed to determine whether future dietary guidelines should incorporate these component-level associations to better support prevention of SLD and liver fibrosis.

Reference:

Dunn N, Patel S, Diaz LA, et al. Dietary guidelines 2025-2030 for Americans are concerning for liver health. Am J Gastroenterol. Published online ahead of print, July 09, 2026. DOI: 10.14309/ajg.0000000000004114