the purpose of this study is to update the prevalence of metabolic syndrome (MetS) and explore to identify the susceptible populations. A total of 38208 subjects aged 18 to 79 years were obtained from the Henan Rural Cohort Study (n = 39259). Five criteria (ATP β, IDF, JIS, CDS, EGIR) were used to estimate the prevalence of MetS. Multivariate logistic regression analysis was used to assess odds ratios (ORs) and 95% confidence interval (CI) of potential risk factors with MetS. The age-standardized prevalence of MetS were 27.87%, 24.63%, 27.40%, 18.00% and 8.91% according to the standard of Atp β, IDF, JIS, CDS, and EGIR, respectively. After adjusted for the potential confounding factors, aging, females, physical activity and the state of drinking were independent risk factors of MetS. MetS is positively associated with stroke and coronary heart disease in all five criteria (P < 0.01). The current data identify a high prevalence of MetS among chinese rural adults. especially for aged females with unhealthy lifestyle had a higher risk for MetS.Settings and participants. This study was conducted from 2015 to 2017 in 5 rural regions (suiping country, Yuzhou country, Xinxiang country, Tongxu country, and Yima country) of Henan province 14 . The target population were permanent residents aged 18-79 years. Those people whose information about the biochemical indicators were deficient were excluded. Ultimately, 38208 participants completed questionnaires, anthropometric measurements and blood tests. Data collection. Each individual completed a standard questionnaire included information on general demographic characteristics, lifestyles, histories of diseases by a face-to-face interview. The education levels were classified into illiteracy, primary school, junior middle school, senior middle school or above groups. The marital status were categorized into married/cohabitation, unmarried/divorced/widowed. The smoking status were classified into current smoker (a person who smoked more than one cigarette per day in the past 6 months) and never smoker. Current drinker was defined as a person who intake alcoholic beverages (spirits, beer, wine, and other alcohol beverages) at least 12 times in the past one year. According to Chinese dietary guidelines 15 , more than 500 g vegetable and fruit daily consumption was defined as more vegetable and fruit intake. A person was considered as high fat diet, who ate more than 75 g meat daily. From the international physical activity questionnaire (IPAQ) 16,17 , physical activity was categorized into three levels: low, moderate, and high. The waist circumference was measured at 1 cm above the navel in a horizontal plane by a non-elastic tape to the nearest 0.1 cm. Height of participants was measured twice without shoes using a wall-mounted ruler tape with an insertion buckle at one end to the nearest 0.1 cm. Body weight was measured once with the subjects in light clothing and barefoot using mechanical scale on a level surface to the nearest 0.1 kg 18 . Body mass index (BMI) was calculat...