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Background & objectives: Emergence of modernization coupled with sedentary lifestyle has led to increase in prevalence and incidence of metabolic syndrome (MetS) among the Asian Indians, including the indigenous peoples, in the last two decades. The objectives of the study was to find out the prevalence of MetS at present, the differences in lifestyle between persons with and without MetS, and the differences in prevalence between two cohorts - the present (2019-20) and previous (2002-19) among the Toto, a small tribal population. Methods: Blood samples were collected in fasting (12h) condition with written consent. Anthropometric measures, blood pressures, lipid profile, and blood glucose were assessed among 306 individuals aged > 20 yrs. For defining MetS the criteria as suggested by National Cholesterol Education Program (NCEP) Adult Treatment Panel III (2005) were used for the present cohort and NCEP ATP III (2001) for comparing with the previous cohort. Results: The prevalence of MetS was 40.2 % including 34.5% males and 46.8%. Significant differences existed between individuals with and without MetS by lifestyle factors. Interaction of gender and age groups had no significant effect on any of the determinants of MetS. The determinants of MetS showed much variability between two cohorts and the prevalence of MetS itself had a significant increase (P< 0.001) in the last two decades. The odds of having MetS are five times higher in the 2019-20 cohort than in the 2002-03 cohort. Interpretation & conclusion: Our study indicates that rapid changes in lifestyle have had adversely affected the cardio-metabolic profile irrespective of generation even among the indigenous peoples, like the Toto. It therefore warrants serious public health attention to provide early detection, proper intervention and lifestyle modifications among the traditional societies keeping in mind the ethnic heterogeneity among people of Indian origin. [ABSTRACT FROM AUTHOR]