Purpose. To examine the prevalence of metabolic syndrome (MS) in Illinois and associated risk factors to document emerging problems as a basis for preventive and/or therapeutic interventions. Design. The 2005 Illinois Behavioral Risk Factor Surveillance System data were analyzed for prevalence rates and relative risk (RR) of risk factors of MS. Setting. Illinois. Subjects. Representative sample of 5077 noninstitutionalized Illinoisans aged >= 18. Measures. Presence of diabetes, hypertension, hypercholesterolemia, angina, and obesity; and adequate fruit/vegetable intake; adequated daily physical activity, routine consumption of calcium-rich foods; smoking; and demographic variables. Analysis. Prevalence, chi-square, RR, and analyses of variance. Results. MS prevalence was 16.2%. The RR for MS was 8 for those having diabetes; 20 for those with hypertension; 14 for those with hypercholesterolemia; 6 for those with angina; and 7 for those with obesity. Fruit/vegetable intake did not significantly influence the RR (RR = 1.01), but RR was greater when calcium-rich foods were not routinely consumed (RR = 1.61) and with inadequate physical activity (RR = 1.85). MS prevalence was highest in those over 65 years; with incomes <$15,000; and among Blacks. Differences among those with one through five indicators of MS were not significant for fruit/vegetable intake, but were for physical activity, age group, income, and education level (p < .001). Conclusion. These findings reveal that MS prevention should be emphasized for lower-income, older Blacks, Increasing physical activity and calcium-rich foods are areas for community-based education. (Am J Health 2008;23[2]:130-138.)