Background: Rising incidence of chronic diseases is a global phenomenon responsible for the greatest increase in burden of disease. Objective: To determine the prevalence of the metabolic syndrome (MetS) in a sample of middle-aged Chinese individuals and the onset of incident diabetes, hypertension, and hyperlipidemia in the ensuing 4 years. Subjects: 638 men and women born in 1956, 1960–1961, and 1964 in Yuci, Shanxi Province, China, were voluntarily enrolled. Method: Longitudinal study collecting anthropometric measures, blood chemistry, behavioral information, and disease information by survey, in 2008 and 2012 in the community health centers of Yuci, China. Data were analyzed using descriptive measures and regression analysis. Results: The rate of MetS in 2008 was 50.95% and 37.15% for men and women (p = 0.001) and in 2012 was 49.52% and 46.26% for men and women (p = 0.438). Regression analysis of the ability of MetS in 2008 to predict disease in 2012 resulted in odds ratios of 2.51 (1.43, 4.41), 26.82 (3.46, 207.68), and 4.06 (2.41, 6.86), for hypertension, diabetes, and hyperlipidemia. Conclusion: MetS has potential as a screening tool to predict incident chronic disease and to aid in improved primary disease prevention.