Linkage Between Hemoglobin to High Density Lipoprotein-Cholesterol Ratio and Metabolic Dysfunction-Associated Steatotic Liver Disease: A Nationally Representative Study.

The rising prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) demands a better understanding of its risk factors. This study aimed to explore the relationship between the hemoglobin to high density lipoprotein-cholesterol ratio (HHR) and MASLD. Data from 3121 participants sourced from the National Health and Nutrition Examination Survey (NHANES) were analyzed. Weighted logistic regression models were constructed to evaluate the associations between HHR and MASLD. Subgroup analyses were conducted to probe potential heterogeneity, and sensitivity analyses, through redefining the CAP cut-off for hepatic steatosis, were employed to affirm the robustness of the observed associations. Increased HHR was independently associated with a higher risk of MASLD. Notably, this association was pronounced among smokers. While a preliminary positive correlation between HHR and liver fibrosis in MASLD patients was noted, it dissipated upon full adjustment. Sensitivity analysis confirmed the stability of the association between HHR and MASLD. Our study reveals a significant positive correlation between HHR and MASLD, with smoking status emerging as a modulatory factor.