Metabolic syndrome (MetS) is associated with an increased risk of cardiovascular disease, type 2 diabetes, and death from all causes. Dietary factors correlate with MetS, making diet a potential target for intervention.

We used data from the 2012–2016 Korea National Health and Nutrition Examination Survey (KNHANES, n = 12,122) to identify a dietary pattern (DP) using 39 predefined food groups as predictors. MetS components were used as the response variable with the food groups in reduced rank regression followed by stepwise linear regression analyses. We then verified the Korean status of the DP externally in the Cardiovascular Disease Association Study (CAVAS) (n = 8,277) and the Health EXAminees (HEXA) study (n = 48,610).

The DP score, which included 20 food groups, showed significant positive associations with all MetS components and a higher prevalence ratio in KNHANES participants (p < 0.0001). Although the score was not significant in CAVAS (p = 0.0913), it showed a strong positive association with MetS prevalence in HEXA (p < 0.0001).

We identified and tested a DP associated with MetS in Korean populations. This DP may be a useful tool for assessing MetS risk. Although the score was linked to higher MetS risk, particularly in the predominantly urban population of the HEXA study, further validation in more diverse populations is needed.