Background and objectives: In the context of healthy aging, geriatric syndromes such as metabolic syndrome (MetS), have been studied in relation to the frailty syndrome as they share underlying physiological mechanisms. They are highly prevalent in the elderly and are independently associated with adverse events. Frailty is a better predictor of mortality than MetS, and studies highlighted the role of the MetS in its onset. It is therefore crucial to prevent MetS elderly for becoming frail. Pre-frailty is an early stage in the frailty development continuum, which has been shown to be both clinically and metabolically reversible. However, data on the prevalence and determinants of MetS-pre-frailty comorbidity are currently Lacking. Therefore, we aimed to describe them in an elderly population. Methods: A cross-sectional analysis was performed using data from 3299 individuals (72.87% men) from the WhiteHall II cohort, aged between 62-86 (means 71.95) years old. MetS was defined following harmonized join statement of MetS (Alberti et al. 2009; doi: 10.1161/circulationaha.109.192644). Frailty was defined according to the Fried phenotype (Fried et al. 2001; doi: 10.1093/gerona/56.3.m146). A multinomial logistic regression model adjusted for age, marital status and sex was performed to find determinants of MetS-pre-frailty comorbidity. Results: The overall prevalence of MetS, pre-frailty syndrome and the comorbidity were respectively 38.6%, 46.9% and 19.6%. Subjects with MetS had a higher prevalence of pre-frailty compared with non-MetS ones (44.5% vs 50.8%; P=0.0004). The comorbidity was more prevalent in men compared to women (20.5% vs 17.3%; P<0.0001). Prevalence of pre-frailty was comparable in subjects suffering from each component of the MetS. In the adjusted model, age (OR:1.12 (95%CI: 1.10-1.14); P<0.0001), being a man (OR:1.30 (1.02-1.65; P=0.03), being single (OR:1.71 (1.23-2.38; P=0.0014), and being widow/divorced (OR:1.44 (1.07-1.94; P=0.0177) were risk factors of the comorbidity. Discussion: Our results highlight a high prevalence of the MetS-pre-frailty comorbidity among the elderly. Given that the co-occurrence of MetS and frailty increases the risk of adverse health events, it is essential that research addresses pre-frailty in the management of patients with MetS. Indeed, pre-frailty is an early and reversible stage, making it a mediator of the consequences of MetS on health status.