BACKGROUND: Metabolic syndrome is a cluster of metabolic abnormalities that can affect a pilot’s health. The aim of the study was to establish the prevalence of metabolic syndrome in the German Air Force.METHODS: All German military pilots are examined regularly at the German Air Force Center of Aerospace Medicine. The data are stored in a special database designed for that purpose. A database query was performed. The following parameters were analyzed: age, duration of observation, BMI, physical working capacity (PWC 170), blood pressure, erythrocyte sedimentation rate (ESR), cholesterol, HDL-cholesterol, triglycerides, fasting blood glucose.RESULTS: For the time period of 1996 to 2016, the data of 12,014 pilots were analyzed. Overall prevalence of metabolic syndrome was 0.9% (95% CI 0.7–1.1%). Participants with a metabolic syndrome had a significantly higher BMI (28.3 vs. 24.1), lower PWC 170 (2.3 vs. 2.7) and higher ESR (4.7 vs. 3.6, mm first hour) than the healthy participants. On average, BMI gradually increased over the years and PWC 170 decreased over the years in all participants. There was no increase of the prevalence of metabolic syndrome during the observational period.CONCLUSION: Prevalence of metabolic syndrome among German Military pilots is low and is not connected to the duration of service.Weber F. Metabolic syndrome in the German Air Force: prevalence and associations with BMI and physical fitness. Aerosp Med Hum Perform. 2018; 89(5):469–472.