OBJECTIVES: The aim of this study was to estimate the prevalence of metabolic syndrome (MS) in patients with schizophrenia according to the presence or absence of negative symptoms. METHODS: A retrospective, cohort study was conducted using electronic medical records from the health provider BSA (Badalona, Spain). All adult outpatients with a diagnosis of schizophrenia were followed for 12 months. Two study groups were defined by the presence or absence of negative symptoms based on the PANSS Marder Negative Symptoms Factor (N1-N4, N6, G7 and G16). MS prevalence was estimated using the NCEP ATP III criteria. Descriptive statistics and logistic regression models were applied. RESULTS: We studied 1,120 patients (mean age: 46.8 ± 13.8 years; male: 58.4%). One or more negative symptoms were present in 52.5% of patients (95%CI: 49.6-55.4%). Dyslipidemia (48.7%), hypertension (38.2%), and diabetes mellitus (19.3%) were the most frequent comorbid conditions. Quetiapine, risperidone and olanzapine were the most common antipsychotic drugs administered. Patients with negative symptoms showed a greater mean number of comorbid conditions than patients without this symptomatology (8.5 and 7.0, respectively; p<0.001). Prevalence of MS was 38.6% (CI: 35.7-41.5%), higher among patients with one or more negative symptoms (43.9% vs. 34.9%, respectively; p=0.002). MS was associated with the presence of negative symptoms, age, and comorbidity (OR=1.6, 1.2, and 1.2, respectively; p<0.05). CONCLUSIONS: Further studies are necessary to elucidate the association between the presence of negative symptoms and MS among patients with schizophrenia as well as the underlying mechanisms involved.