AIMS: Results regarding the association between fish intake and risk of metabolic syndrome (MetS) are ambiguous. Therefore, this study aims to evaluate whether there is an association between fish consumption and risk of MetS. DATA SYNTHESIS: A comprehensive literature search was conducted of PubMed, Embase, ScienceDirect and Google Scholar up to August 2019. A random-effects model was used to pool the risk of MetS in the highest category of fish consumption compared with the lowest one. Subgroup analysis was conducted based on country of region, gender, dietary tool, MetS definition, energy adjustment and sample size. A dose-response of analysis of fish intake and risk of MetS was also conducted. Twelve studies with a total of 16 effect sizes (10 cross-sectional and six cohort) were included. An inverse association was observed between fish intake and risk of MetS in cohort (OR = 0.80, 95% CI: 0.66, 0.96; P = 0.017, I(2) = 62.9%) but not cross-sectional studies (OR = 0.80, 95% CI: 0.70, 1.02; P = 0.085, I(2) = 50.1%). Subgroup analysis suggested that the results were influenced by all the included variables but sample size. A significant non-linear association was observed between fish intake levels and risk of MetS (P-value for non-linearity = 0.010). CONCLUSION: An inverse association existed between fish intake and risk of MetS when combining data from prospective cohort studies. Further studies are needed to confirm such an effect.