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Background Little is known about how adverse, midlife metabolic profiles affect future physical functioning. We hypothesized that a higher number of midlife metabolic syndrome (MetS) components are associated with poorer physical performance in early old age for multiethnic women. Methods MetS status from 1996 to 2011 (8 visits) and objective physical performance in 2015/2016 (Short Physical Performance Battery [SPPB; 0–12], 40-foot walk [meter/second], 4-meter gait speed [meter/second], chair stands [seconds], stair climb [seconds]) were assessed in the Study of Women’s Health Across the Nation (SWAN; n = 1722; age 65.4 ± 2.7 years; 26.9% African American, 10.1% Chinese, 9.8% Japanese, 5.5% Hispanic). Poisson latent class growth modeling identified MetS component trajectory groups: none (23.9%), 1 = low-MetS (28.7%), 2 = mid-MetS (30.9%), and ≥3 = high-MetS (16.5%). Adjusted linear regression related MetS groups to physical performance outcomes. Results High-MetS versus none had higher body mass index, pain, financial strain, and lower physical activity and self-reported health (p &amp;lt; .0001). Compared with White, African American and Hispanic women were more likely to be in the high-MetS groups and had worse physical functioning along with Chinese women (SPPB, chair stand, stair climb, and gait speed—not Hispanic). After adjustments, high-MetS versus none demonstrated significantly worse 40-ft walk (β: −0.08; 95% CI: −0.13, −0.03), gait speed (β: −0.09; 95% CI: −0.15, −0.02), SPPB (β: −0.79; 95% CI: −1.15, −0.44), and chair stands (β: 0.69; 95% CI: 0.09, 1.28), but no difference in stair climb. Conclusions Midlife MetS groups were related to poor physical performance in early old age multiethnic women. Midlife management of metabolic function may improve physical performance later in life.

Metabolic Syndrome Trajectories and Objective Physical Performance in Mid-to-Early Late Life: The Study of Women’s Health Across the Nation (SWAN)