BACKGROUND AND AIMS: Prospective studies found associations between serum uric acid (SUA) and incident metabolic syndrome (MetS) with high heterogeneity. We investigated the association between SUA and incident MetS and its components in a region highly burdened by cardiometabolic disorders. METHODS AND RESULTS: The study included 1999 adults (1297 women). MetS was defined according to the Joint Interim Societies' criteria. Multivariate adjusted Cox proportional hazard analyses were applied to examine the association between SUA and outcomes. During a median follow-up of 9.7 years, 833 (510 women) incident MetS cases occurred. Among the whole population, a higher risk of MetS was observed across quartiles (Q1-4) of SUA even after adjustment for Homeostasis Model Assessment for Insulin Resistance (HOMA-IR), [multivariate hazard ratio (95 % confidence interval) in Q4: 1.58 (1.17-2.14), Q1: as reference]. Generally, same association was found for women. Similarly, a 1-standard deviation (SD) increase of SUA was associated with a higher risk of incident MetS in the whole population, and women [1.19 (1.06-1.34) and 1.14 (1.02-1.28), respectively]. Among men, the association was just in the age-adjusted analysis, however, no effect modification of gender was found. Moreover, a 1-SD increase in SUA elevated the risk of incident high-waist circumference (20 %), -fasting plasma glucose (19 %), -triglycerides (17 %), and low-high-density lipoprotein cholesterol (12 %) after adjustment for other MetS components and HOMA-IR in the whole population (all Ps <
0.05). CONCLUSION: SUA was associated with incident MetS and its components, excluding hypertension, and might be a potential biomarker for identifying individuals at risk of developing MetS.