This study investigated the associations between health habits, chronic diseases, sleep apnea, mental health, nutritional status, and neck circumference as a marker of upper body fat in middle-aged Koreans. A total of 2,612 participants aged 40~64 years from the 2023 Korea National Health and Nutrition Examination Survey were included in the analysis. The participants were divided into tertiles based on the neck circumference. The anthropometric characteristics, such as height, weight, body mass index, and waist circumference were positively associated with the neck circumference tertiles. The participants in the highest neck circumference tertile exhibited significantly higher systolic and diastolic blood pressures, fasting blood glucose, glycated hemoglobin, triglycerides, hemoglobin, and uric acid levels, whereas high-density lipoprotein cholesterol was higher in the lowest tertile. Logistic regression analysis showed that the highest neck circumference tertile, compared to the lowest, was significantly associated with the following factors: heavy drinking (odds ratio [OR]: male 1.63), alcohol intake (OR: female 1.52), hypertension (OR: male 3.99, female 4.44), diabetes (OR: male 4.08, female 8.42), hypercholesterolemia (OR: male 2.21, female 2.28), hypertriglyceridemia (OR: male 3.68, female 5.91), metabolic syndrome (OR: male 9.21, female 16.74), hyperuricemia (OR: male 3.48, female 3.71), sleep apnea (OR: male 1.67~2.65, female 1.36~3.02), stressful mental status (OR: male 1.43, female 1.48), depression (OR: male 3.06, female 1.89), and poor vitamin C intake status (OR: female 1.50). These findings suggest that neck circumference is significantly associated with cardiovascular risk factors, including drinking, chronic diseases, sleep apnea, and mental health status, and may serve as a useful anthropometric marker of cardiovascular risk in middle-aged populations.