Dietary Guidelines 2025-2030 for Americans are Concerning for Liver Health.

INTRODUCTION

The 2025-2030 Dietary Guidelines for Americans (DGA-2025) introduced substantial changes in nutrition recommendations, including greater emphasis on total protein intake and omission of previous alcohol guidance. We evaluated how individual dietary components-derived from both Healthy Eating Index-2020 (HEI-2020) and z-score models-relate to steatotic liver disease (SLD), fibrosis, and cirrhosis in US adults.

METHODS

We analyzed data from 10,944 adults (National Health and Nutrition Examination Survey 2017-2023) with 24-hour dietary recall and vibration-controlled transient elastography. Dietary exposures included HEI-2020 component scores and energy-adjusted z-scores for DGA-2025-aligned food groups. An alcohol adherence score was derived based on previous DGA-2020 thresholds. Logistic regression and stepwise models were adjusted for sociodemographics, diabetes, obesity, caffeine, and survey design.

RESULTS

Several HEI-2020 and z-score components were consistently associated with liver outcomes. High 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. By contrast, higher intake of red/processed meats, sodium, total protein, saturated fat, and added sugars was associated with a greater prevalence. Alcohol adherence scores were strongly protective across all outcomes. In stepwise models, greens and beans, seafood and plant protein, saturated fat, and alcohol use were retained as independent predictors. Notably, components emphasized in DGA-2025-such as total protein and red meat-were associated with greater fibrosis risk, whereas several protective components (e.g., greens and beans, seafood/plant protein) were omitted from the updated guidelines.

DISCUSSION: HEI-2020 and z-score models identify multiple protective and adverse dietary components associated with SLD and fibrosis. The findings underscore the importance of component-level nuance-particularly regarding protein sources and alcohol intake-when formulating dietary guidance for liver health.