Assessment of neck to height ratio as a predictive tool for metabolic dysfunction-associated steatotic liver disease in Korean adults: a cross-sectional analysis from Korea National Health and Nutrition Examination Survey 2019–2021

A total of 11,414 participants aged 40 years or older were included in the study. Participants in the highest NHtR quartile had higher levels of metabolic risk markers, including body mass index, waist circumference, glucose, hemoglobin A1c, and homeostatic model assessment of insulin resistance (P<0.001). In logistic regression analysis, the odds ratio for MASLD in quartile 4 compared to quartile 1 was 1.77 (95% confidence interval [CI], 1.31-2.40; P<0.001) in the fully adjusted model. The area under the curve and 95% CI of NHtR for MASLD were 0.749 (95% CI, 0.740-0.758), demonstrating superior accuracy compared with other indicators. The optimal NHtR cut-off for MASLD was 21.564, with a sensitivity and specificity of 0.726 and 0.644, respectively. Conclusion: NHtR is a more effective predictor of MASLD than other measures, highlighting its potential as a valuable screening tool in clinical and self-care settings.