Abstract
Background/Objectives: Metabolic syndrome (MetS) comprises a cluster of cardiometabolic risk factors that vary dynamically under environmental and behavioral influences. Although there are data suggesting seasonal variability in individual metabolic components, few studies have comprehensively assessed MetS as a composite condition across seasons using a large, nationally representative population. In this study, we aimed to evaluate the seasonal and monthly patterns of MetS prevalence and component burden, with a focus on sex-specific differences. Methods: We analyzed 5,507,251 health screening records from 2,057,897 Korean adults aged ≥40 years between 2013 and 2022, obtained from the National Health Insurance Service database. Seasons were categorized as: spring (March-May), summer (June-August), fall (September-November), and winter (December-February). Trends in MetS prevalence and its components were evaluated monthly and seasonally, stratified by sex. Results: MetS prevalence significantly varied by season in both sexes (p < 0.001), ranging from 30.2% to 34.5% in men and from 21.5% to 25.5% in women. Among men, a U-shaped pattern was observed, with the lowest prevalence during summer and a progressive increase through winter. Women showed a steady decline in prevalence from January to September, followed by a slight rebound. Winter was associated with increased odds of MetS in both sexes. A significant interaction between sex and season (p for interaction < 0.001) indicated the presence of sex-specific temporal patterns. Conclusions: This nationwide study revealed clear seasonal variation in MetS prevalence and component burden, with sex-specific patterns. These findings highlight the importance of incorporating seasonality and sex in cardiometabolic risk assessments and public health interventions.