OBJECTIVES:  To contrast the factors that are associated with metabolic syndrome risk for US adolescents overall and US Hispanic adolescents. METHODS: At risk is defined as having three or more of the following: elevated fasting glucose, elevated SBP,  elevated DBP, elevated triglycerides, elevated BMI, elevated waist circumference, or low HDL. Logistic regression and NHANES 2003-2006 data were used to examine the impact on metabolic syndrome risks; gender, race, ethnicity, immigrant status, income, insurance, parental education, activity levels, number of school lunches and breakfasts per week, milk consumption, language preference, and number of meals outside the home per week. US adolescents overall were compared with US Hispanic adolescents. Weighted sample sizes for Hispanic adolescents and US born adolescents were 8,178,714, and 50,837,204 respectively. At risk is defined as having three or more of the following: elevated fasting glucose, elevated SBP,  elevated DBP, elevated triglycerides, elevated BMI, elevated waist circumference, or low HDL. Logistic regression and NHANES 2003-2006 data were used to examine the impact on metabolic syndrome risks; gender, race, ethnicity, immigrant status, income, insurance, parental education, activity levels, number of school lunches and breakfasts per week, milk consumption, language preference, and number of meals outside the home per week. US adolescents overall were compared with US Hispanic adolescents. Weighted sample sizes for Hispanic adolescents and US born adolescents were 8,178,714, and 50,837,204 respectively. RESULTS: The results of the regressions were vastly different between US adolescents and US Hispanic (First Generation and Native) adolescents. All variables in the models were statistically significant. Where US adolescent females faced a lower risk (42%) of having metabolic syndrome, US Hispanic females faced a higher risk (17%). Notably, for those Hispanics that were first generation, risk increased by 65%.  For US adolescents overall, low or middle income levels increased risk three times, while low and middle income level US Hispanic adolescents had a risk decrease of 77% and 69% respectively. For every meal eaten outside the home per week (excluding school meals) metabolic syndrome risk increases for US adolescents by 4% and by 13% for Hispanic US adolescents. CONCLUSIONS:Adolescents with metabolic syndrome are at risk for acute cardiovascular endpoints, higher medical utilization and expenditure, and lower quality of life. Interventions should focus on education regarding healthy eating outside the home despite limited financial resources. A surprising result of this analysis is the high price of acculturation for Hispanic first generation adolescents.