INTRODUCTION: Metabolic syndrome in reproductive-age women increases lifetime cardiometabolic risk and may reflect socioeconomic inequality. We evaluated whether education and household income are associated with metabolic syndrome prevalence in a nationally representative sample. METHODS: We conducted a cross-sectional analysis of National Health and Nutrition Examination Survey (NHANES) 2017–2023 data for women aged 20–45 years. Modified metabolic syndrome was defined as meeting three or more of five components: central obesity, low high-density lipoprotein (HDL) cholesterol, elevated blood pressure or antihypertensive use, elevated fasting glucose or diabetes medication, and high non-HDL cholesterol or lipid-lowering therapy. Exposures were educational attainment (high school or less versus some college education or higher) and family income-to-poverty ratio (less than 2.0 versus 2.0 or greater). Analyses incorporated the NHANES complex survey design and fasting subsample weights to yield nationally representative estimates. Age-adjusted Poisson regression with a robust standard errors estimated prevalence ratios (PRs). RESULTS: Among 1,424 women aged 20–45, the weighted prevalence of modified metabolic syndrome was 29.7%. Prevalence was 30.9% for women with high school education or less versus 29.2% for some college education or higher (PR 1.10; 95% CI, 0.88–1.39; P =.395). Prevalence was 33.0% for family income-to-poverty ratio less than 2.0 versus 27.6% for 2.0 or greater (PR 1.27; 95% CI, 1.01–1.61; P =.045). CONCLUSIONS/IMPLICATIONS: Nearly one in three U.S. women aged 20–45 meets criteria for modified metabolic syndrome. Income is significantly associated with higher prevalence while education shows a similar direction but becomes nonsignificant after age adjustment. These findings support prioritizing preconception counseling, screening, and prevention for lower-income patients and emphasize addressing social risk in equitable cardiometabolic care.
Byun et al. (2026) studied this question.