Background & aims: Falls are a major threat for patients with Parkinson's disease, as they are associated with higher risk of morbidity, loss of functional ability, institutionalization, and mortality. Metabolic syndrome (MetS) is associated with poorer physical performance in middle age, but its impact in the older and frailer subjects is unclear. The present study aimed at assessing the association of MetS with falls in patients with Parkinson's disease. Methods: We analyzed data of 194 elderly with Parkinson's disease attending a geriatric Day Hospital. History of falls that occurred over the last year, as well as and the number of falls, were recorded. Metabolic syndrome was diagnosed according to the National Cholesterol Education Program's ATP-III criteria. Results: Falls were reported by 91 participants (47%). Logistic regression analysis showed that MetS was associated with reduced occurrence of falls (OR = .26; 95% CI = .10.69; P = .007). Also, among participants who fell, Poisson regression indicated that MetS predicted a reduced number of falls (IRR = .43; 95% CI = .20.89; P = .024). Conclusions: In our population MetS was associated with reduced probability of falls; among subjects who fell, MetS was associated with a reduced number of falls. Dedicated studies are needed to better understand the subsystems involved, as well as the therapeutic implications of such an association. (C) 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.