To examine the association between serum uric acid and metabolic syndrome risk, uric acid concentrations and metabolic syndrome (ATP-III criteria) were assessed in 1877 subjects, in a population-based study with a high MS prevalence (39%). Linear regression analysis of serum uric acid levels in a model comprising 13 variables disclosed that waist girth was the most important independent determinant. Adjusted logistic regression analysis of serum uric acid for metabolic syndrome revealed for the top versus bottom tertile an odds ratio of 1.89 (95% CI: 1.45-2.46). This corresponded to a 35% increase in metabolic syndrome risk for each 1 SD serum uric acid increment. After inclusion of waist girth into the model, the rate decreased to 15% but remained significant, which suggests that serum uric acid is an independent determinant of metabolic syndrome.