Background: Metabolic syndrome (MetS) is a cluster of cardiometabolic abnormalities associated with cardiovascular disease and diabetes. This study assessed the prevalence, distribution of metabolic syndrome components, and associated factors among adults attending the medical outpatient clinic at Bugando Medical Centre (BMC), Mwanza, Tanzania. Methods: This hospital-based cross-sectional study was conducted from May to June 2022 among adults aged ≥18 years attending the BMC medical outpatient clinic. Participants were selected by systematic sampling. Sociodemographic, lifestyle and clinical information was collected using a structured questionnaire. Blood pressure, body weight, height and waist circumference were measured, and fasting blood samples were analyzed for glucose, triglycerides, high-density lipoprotein cholesterol, C-reactive protein and serum uric acid. MetS was defined using International Diabetes Federation (IDF) and National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Univariable and multivariable logistic regression were used to assess associated factors. Results: Of 219 patients screened, 197 were eligible and 181 consented to participate. The median age was 58 years and 107 (59.1%) were female. MetS was present in 84 (46.6%) participants by IDF criteria and 69 (38.1%) by ATP III criteria. Hypertension was the most common component (159, 87.8%), followed by central obesity by IDF criteria (115, 63.5%). Physical activity of less than 150 minutes/week was associated with higher odds of MetS (odds ratio [OR] 4.17, 95% confidence interval [CI] 1.49–11.11; p=0.008). Obesity (body mass index [BMI] ≥30 kg/m²) was also associated with higher odds of MetS (OR 8.44, 95% CI 2.35–30.25; p=0.001). Conclusion: MetS was common among adults attending the BMC medical outpatient clinic.