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Objectives: This study was performed to investigate the prevalence and clinical characteristic of the metabolic syndrome in middle aged Korean adults. Subjects and Methods: This Chungju Metabolic Syndrome (CMS) study was performed for 4 consecutive years, 2003-2006 on total 11,526 individuals (4,711 men and 6,815 women) selected by the stratified random cluster sampling among adults over 40 years old in Korea. The metabolic syndrome was defined based on both the NCEP criteria and Modified NCEP (Mod-NCEP) criteria using the WHO-APR(Asian Pacific Region)'s abdominal obesity criteria (waist circumference >90 cm in men, >80 cm in women) as well as International Diabetes Federation (IDF) criteria. Results: Using NCEP criteria, the age-adjusted overall prevalence of metabolic syndrome was 24.0% (18.5% in men, 27.8% in women). Age-adjusted overall prevalence of metabolic syndrome as defined by Mod-NCEP and IDF criteria was 34.0% and 27.2%. Prevalences of the metabolic syndrome as defined by IDF criteria for each age group (40-49, 50-59, 60-69, ≥ 70) in men were as follows: 20.3%, 18.9%, 17.5%, 11.8%. In women: 26.5%, 37.9%, 41.9%, 37.8%. Amount of alcoholic drinking and current smoking status of men were highest in age 40-49 and then decreased with aging, whereas amount of exercise was highest and current smoking status of women was lowest in 40-49 year old women and then increased. Conclusions: Interestingly, peak age of the metabolic syndrome in men was age 40-49, and prevalence decreased with aging regardless of type of definition. On the other hand, prevalence of the metabolic syndrome in women was abruptly increased after menopause (in age 50-59) and then gradually increased. Some proposed that recent increments of obesity and the metabolic syndrome in Asian population including Korean are resulted from "thrifty gene hypothesis". Our study results might suggest that men are more susceptible to environmental factor than women, whereas women are likely to be influenced by aging process or menopausal status rather than "thrifty gene". [ABSTRACT FROM AUTHOR]