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Cigarette smoking is a risk factor for type 2 diabetes and cardiovascular disease. Not known is whether smoking habit is associated with the risk of developing the metabolic syndrome among men. Study subjects consisted of 7355 Japanese men aged 40 to 55 years without the metabolic syndrome. The metabolic syndrome was defined using modified Adult Treatment Panel III criteria using body mass index in place of waist circumference. Data on smoking habit was obtained from questionnaires. During the 4-year follow-up period, we confirmed 806 cases of the metabolic syndrome. After adjustment for age, body mass index, systolic blood pressure, diastolic blood pressure, triglycerides, HDL cholesterol, fasting plasma glucose, alcohol daily consumption, and physical activity, the odds ratio (OR) of the metabolic syndrome among current smokers was 1.30 (95% confidence interval (CI) 1.04-1.61) in comparison to never smokers. Men who smoked more than 30 cigarettes a day had a higher risk compared with never smokers (OR 1.61, 95% CI 1.16-2.24) (Table 1). To evaluate the chronic effect of cigarettes smoking for the risk of the incidence of the metabolic syndrome, we assessed the relationship between pack-years and the risk of the metabolic syndrome. The value of pack-years is also associated with the increased risk of the metabolic syndrome in a dose-dependent manner. The multiple-adjusted OR for those whose pack-years value is more than 40 is 1.49 (95% CI 1.12-1.98). Furthermore, we assessed the association between cigarettes smoking and the incidence of the components of the metabolic syndrome. Cigarette smoking was associated with the risk of the incidence of hyperglycemia, high triglycerides, and low HDL cholesterol but not high blood pressure or high body mass index. In conclusion, cigarette smoking habit is an independent risk factor for the development of the metabolic syndrome. [ABSTRACT FROM AUTHOR]