A decrease in metabolic syndrome (MetS) prevalence may lower the cardiovascular disease (CVD) burden. The predictive value of nutritional recommendations for the incidence of MetS has not yet been evaluated. We assessed, in a populationbased study, the association between the French National Nutrition and Health Program Guideline Score (PNNS-GS) and 6-y risk of MetS. Participants in the Supplé mentation en Vitamines et Miné raux Antioxydants study were followed-up from 1994-1996 to 2001-2002. MetS was defined according to International Diabetes Federation criteria. We also defined "mild" and "severe" MetS as waist criteria plus 2, or more than 2, other criteria. Prospective associations between the PNNS-GS at baseline (either as a continuous variable or in quartiles) and incident MetS were assessed using binary or multinomial logistic regression to provide OR and 95% CI in participants free of MetS at baseline (n = 2763). In multivariate models, each unit increase in the PNNS-GS score was associated with a 9% lower risk of MetS (OR = 0.91; 95% CI = 0.83-1.00). This association was even stronger with the risk of severe MetS (OR = 0.76; 95% CI = 0.63-0.91). After adjustment for baseline and change in BMI, this association remained significant for severe MetS but did not reach significance for overall MetS. These findings support a potential beneficial impact of nutritional guidelines upon primary prevention of MetS. Improvement in compliance with nutritional recommendations may help to reduce the burden of CVD disease in the general population. (R.A.)