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Objective: The aim of this study was to estimate MS prevalence according to three criteria and its risk factors among men in rural China. Design: Cross-sectional study. Setting: The Nantong Metabolic Syndrome Study (NMSS) was conducted during 2007-2008 in Nantong, China. Participants: 6997 male participants aged 18-74 years. Measurements: In person interviews, blood glucose and lipid measurements were accomplished. Results: The prevalence of MS was 12.86%, 8.55% and 15.28% according to IDF, ATPIII and ATPIII-modified criteria, respectively. The IDF and ATP III-modified criteria agreed only moderately with ATP III criteria (ϰ= 0.56 and 0.68), whereas ATP III-modified and the IDF criteria agreed perfectly (ϰ= 0.90). Vigorous occupational physical activity was associated with a low prevalence of MS with Odds ratio (OR) of 0.58 (95% confidence interval (CI): 0.45-0.74). Beer drinkers (alcohol ≤ 6.2 g/day) and rice wine drinkers (alcohol ≤ 9.0 g/day) had about 34% and 33% low risks of developing MS respectively, compared with non-drinkers. OR of MS was 1.95 (95% CI: 1.39-2.73) in men who had familial history of at least two diseases, including hypertension and diabetes, compared with men without familial history of those diseases. Conclusions: Our data suggested that MS is highly prevalent among men in rural China. Family history of diabetes and hypertension is a risk factor in MS development. Physical activity, rice wine and beer consumption are associated with a significantly lower risk. [ABSTRACT FROM AUTHOR]