Few studies have researched the gender-specific effects of electronic nicotine delivery systems on the metabolic syndrome (MetS) and/or its risk factors (central obesity, raised triglycerides, decreased HDL cholesterol, raised blood pressure, raised fasting plasma glucose). Thus, this study investigated the association between smoking behavior (cigarette type, smoking history) and MetS in a nationally representative sample of Korean men and women. Our study employed data for 5,462 cases of MetS and 12,194 controls from the Korea National Health and Nutritional Examination Survey (KNHANES) for the years 2014 to 2017. Logistic regression analysis was employed to determine the association between type of cigarette (non-smoker, ex-smoker, and current smoker-conventional only, current smoker-conventional and electronic) and the prevalence of metabolic syndrome and its risk factors. Smoking history was clinically quantified by pack-year. No association between cigarette type and MetS was found for men. For women, relative to non-smokers, smokers of conventional cigarettes (OR 1.80, 95% CI 1.02-3.18) and both conventional and electronic cigarettes (OR 4.02, 95% CI 1.48-10.93) had increased odds of MetS. While there was no association between smoking history and MetS for women, for men, conventional smoking history was associated with MetS for individuals with a smoking history of > 25 pack-years (> 25 to ≤ 37.5 OR 1.45, 95% CI 1.04-2.02; > 37.5 to ≤ 50 OR 1.53, 95% CI 1.08-2.18; > 50 OR 1.56, 95% CI 1.07-2.27). Sex differences were found in the association between smoking behavior and MetS. Such findings reveal sociodemographic differences that should be considered for interventions regarding conventional and/or e-cigarette users at risk of metabolic complications. The metabolic syndrome (MetS) and its risk factors (central obesity, raised triglycerides, decreased HDL cholesterol, raised blood pressure, raised fasting plasma glucose) have been vital in helping identify individuals at risk of type 2 diabetes and cardiovascular disease (CVD). Although a catalyst for heart disease, lipid problems, hypertension, dementia, cancer, polycystic ovarian syndrome, and non-alcoholic fatty liver disease 1 , the mechanisms underlying the development of MetS remain obscure. What is certain is that a growing body of literature asserts that various lifestyle factors including smoking, alcohol consumption 2 , diet, and physical activity 3 contribute to its onset. Electronic nicotine delivery systems, also known as e-cigarettes, are battery-powered products that deliver nicotine in the form of an aerosol 4. Currently, the ever use of e-cigarettes is 8.5% in the United States and 6.6% in South Korea 5. Often advertised as a "healthier" alternatives to conventional cigarettes or smoking cessation aids, e-cigarettes purportedly do not involve tobacco combustion and therefore, have reduced toxicant exposure compared to traditional cigarettes 6. However, research on long-term toxicity has been limited and studies attempting to show the effica...