Purpose To examine the relationship of metabolic syndrome (MetS) and its components with retinal microvascular abnormalities in a rural Chinese population.

Design  A population-based survey.

Methods The Handan Eye Study recruited 6830 (90.4% of eligible) rural Chinese aged 30 or older. The metabolic syndrome was diagnosed following definitions of the International Diabetes Federation. Retinal microvascular signs were assessed from fundus photographs by graders who were trained at the Retinal Vascular Imaging Centre, University of Melbourne. Retinal arteriolar and venular diameters were measured using a specific computer-assisted program.

Results Of 7557 eligible individuals, 6830 (90.4%) participated in the study, but only 5519 (81% of 6830) who had all the relevant data and thus included in this report. After adjusting for age, participants with the MetS, or with components of larger waist circumference, higher blood pressure or higher FPG, were more likely to have retinopathy, arteriovenous nicking, focal arteriolar narrowing, enhanced arteriolar wall reflex and generalized retinal arteriolar narrowing than those without the MetS or the corresponding component. Persons with a larger waist circumference were significantly more likely to have arteriovenous nicking and enhanced retinal arteriolar reflex and retinopathy lesions; persons with higher triglyceride levels were significantly more likely to have arteriovenous nicking and retinopathy; persons with higher FPG levels were significantly more likely to have enhanced retinal arteriolar reflex and retinopathy, and those with higher blood pressure levels were significantly more likely to have severe focal arteriolar narrowing, severe arteriovenous nicking, an enhanced arteriolar wall reflex and retinopathy.

Conclusions We reported cross-sectional associations of the MetS with retinal microvascular signs and retinal vessel diameter in rural Chinese adults. These data suggest that individual components of the MetS were associated with different retinal microvascular signs and with the diameters of central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE).