Abstract Background The incidence of metabolic syndrome progressively increases among the urban population of Europe. About 1/3 of the Bulgarian adults have metabolic syndrome. Changing the dietary pattern can be a modern approach to control it. The aim of the study is to investigate the eating model of people with metabolic syndrome according to the Bulgarian dietary guidelines. Methods Two hundred individuals with metabolic syndrome aged 54.6±10.5 y. were randomly selected from general practitioners’ practices in Pleven region, Bulgaria. A Food Frequency Questionnaire method was applied to assess the eating pattern of the respondents. The frequency of food consumption of different foods was compared with the dietary guidelines for the Bulgarian population over 18 years of age. Data were processed with IBM SPSS v. 25. Results Grain consumption met the recommendations in almost all respondents. Only 29% consumed fresh fruits and 42% had intake of milk and milk products according to the requirements. Women ate more fresh vegetables and fruits and dairy products than men (p = 0,032). Risk meat consumption, 2-4 times a week, was found: men preferring more red meat (45%) and women - chicken and poultry (56%). Fish consumption met recommendation (once a week) in only 14.7% of the respondents. The food intake of eggs, vegetables, legumes and nuts were low. The preferred oils were sunflower and olive (once a day by 86% and 15% respectively), and butter (21% - 2-4 times a week). The intake of table salt corresponds to the recommendations in two thirds of the participants. One third consumed confectionery every day. Half did not drink alcohol, but 16% used concentrates once a day. Conclusions Foods that increase the nutritional risk for the development of metabolic syndrome and type 2 diabetes - high consumption of confectionery and red meat, low consumption of vegetables, fish and legumes were found. Unbalanced eating model requires new public initiatives to prevent metabolic syndrome. Key messages • Men with metabolic syndrome have a higher consumption of unhealthy foods than women. • Modern Bulgarian dietary guidelines are an important tool for prevention of metabolic syndrome.