Prevalence and agreement between metabolic syndrome definitions among rural and urban adults in the Ashanti Region of Ghana

Sub-Saharan Africa is undergoing an epidemiological transition associated with urbanization, dietary change, and reduced physical activity, contributing to an increasing burden of cardiometabolic disorders. Estimates of metabolic syndrome (MetS) vary because diagnostic criteria differ. In Ghana, few studies have directly compared commonly used MetS definitions within a single population. This study assessed MetS prevalence among rural and urban adults in Kumasi, Ghana using the World Health Organization (WHO 1999), National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III 2005), and Joint Interim Statement (JIS 2009) criteria, and examined agreement between these definitions. We conducted a facility-based cross-sectional study among 200 adults attending diagnostic laboratories in rural and urban districts of the Ashanti Region. MetS was classified using WHO, NCEP-ATP III, and JIS criteria. Differences in prevalence by residence were examined using chi-square tests. Agreement across definitions was assessed using Cohen’s kappa and McNemar’s test. Comparative classification characteristics between definitions were evaluated using contingency tables. MetS prevalence ranged from 10.0% using WHO criteria to 16.0% using JIS criteria, with NCEP-ATP III yielding 12.0%. No significant rural–urban differences were observed under any definition (all p > 0.05). Agreement between definitions ranged from κ = 0.78 to 0.92. Across pairwise comparisons, sensitivity ranged from 75.0% to 93.8% and specificity from 97.0% to 99.0%. MetS prevalence varied by diagnostic definition but was similar between rural and urban participants in this facility-based sample. The JIS criteria identified the highest prevalence, indicating broader classification of individuals with clustered cardiometabolic risk factors.