Objective This study examines the association between 40 occupational groups and baseline prevalence and incidence of metabolic syndrome (MetS), separately for male and female workers, and whether age and health behaviors can explain the association.

Methods Data from 74,857 Lifelines Cohort and Biobank Study participants were used to regress occupational group membership, coded by Statistics Netherlands, on the prevalence and incidence of MetS using Logistic and Cox-regression analyses. MetS diagnosis was based on physical examinations, blood analysis, and recorded medication use. Information on age, smoking status, physical activity, diet and alcohol consumption was acquired using questionnaires.

Results MetS prevalence was 17.5% for males and 10.6% for females. In the fully adjusted models, three occupational groups were associated with increased MetS prevalence in both sexes. Three additional occupational groups were associated with MetS among men, nine among women. Strongest associations were found for male ‘hospitality, retail and other service managers’ (odds ratio (OR): 1.65; 95% confidence interval (CI): 1.03–2.65) and female ‘stationary plant and machine operators’ (OR: 3.44; 95% CI: 1.57–4.54). During a median 3.8-year follow-up, MetS incidence was 7.8% for males and 13.2% for females. One occupational group was associated with an increased MetS risk in both sexes. Six additional occupational groups had an increased risk for MetS among men, four among women. Highest risks were found for male ‘stationary plant and machine operators’ (hazard ratio (HR): 1.94; 95% CI: 1.26–3.00) and female ‘food preparation assistants’ (HR: 1.80; 95% CI: 1.01–3.22).

Conclusion Findings indicate that occupational group matters for men and women in MetS development, and that differences in MetS prevalence across occupations are not merely a reflection of selection of metabolically unhealthy workers into specific occupations. The striking sex differences in the occupational distribution of MetS indicates that preventive measures should, with some exceptions, target men and women separately.