Background: Metabolic syndrome (MetS) is a prevalent concern among patients with schizophrenia, increasing their risk for cardiovascular disease and mortality. This study aims to investigate the prevalence of metabolic abnormalities and MetS in Chinese patients with chronic schizophrenia and identify key predictors associated with different metabolic risk categories. Methods: A cross-sectional study involving 632 schizophrenia patients was conducted, classifying them into MetShigh-risk (n = 99), MetS-borderline (n = 359), and MetS-confirmed (n = 174) groups. Data on demographic characteristics, endocrine-related information, schizophrenia-related information, and metabolic indicators were collected. Hierarchical regression analyses were performed to identify factors distinguishing the three MetS risk categories. Results: Metabolic abnormalities were found in 84.33 % of patients, with a MetS prevalence of 27.53 %. Higher BMI, endocrine disorders, and metabolic indicators such as larger waist circumference, elevated fasting blood glucose, and high blood pressure were identified as consistent predictors of MetS and were associated with differences in metabolic risk status. Olanzapine/Clozapine use significantly predicted metabolic abnormalities and differences between high-risk and borderline status. Additionally, younger age and later schizophrenia onset were associated with differences between high-risk and borderline status, as well as between borderline and confirmed MetS. Male gender and a family history of psychiatric disorders significantly predicted the differences between borderline status and confirmed MetS. Conclusions: This study highlights the substantial prevalence of metabolic abnormalities and MetS among chronic schizophrenia in China. The identified predictors underscore the importance of early detection and intervention to mitigate metabolic risks. Future research should focus on longitudinal studies to better understand the interplay between genetic, lifestyle, and treatment factors in managing metabolic health in schizophrenia.