Objectives <p>This study evaluated the Association between anthropometric measures and metabolic syndrome in Iranian professional drivers.</p> Methods <p>In this study, 1461 professional drivers were assessed in the first cross-sectional phase of the Shahroud drivers’ prospective cohort study. Anthropometric indices: height, weight, waist, neck, wrist, hip circumference, body mass index, waist-hip ratio, waist-to-height ratio, height-to-wrist circumference ratio, and height-to-neck circumference ratio were measured. The Receiver operating characteristic curve (ROC) determined the best marker for diagnosing metabolic syndrome among different anthropometric indices. Also, the sensitivity and specificity of the anthropometric index were assessed.</p> Results <p>The study found that the mean values of anthropometric indices were significantly higher in participants with metabolic syndrome compared to those without metabolic syndrome. The body mass index and waist-to-height ratio were identified as the best predictors of metabolic syndrome among different anthropometric indices. The authors suggest that the optimal cut-off points for body mass index and waist-to-height ratio among drivers should be set at 25.2 and 0.53&#xa0;kg/m², respectively.</p> Conclusions <p>Waist-to-height ratio and body mass index are better predictors of metabolic syndrome than other anthropometric indices. The study’s findings may have implications for developing targeted interventions to prevent metabolic syndrome and its associated health outcomes among professional drivers in Iran.</p>