Background: Shift work, particularly in night shifts, has been linked to adverse health outcomes, including disruptions in circadian rhythms that may contribute to metabolic disorders. However, sexrelated differences in the impact of night shift work on cardiometabolic health remain understudied.This study sought to examine the relationship between night shift work and cardiometabolic health in young adults, identifying potential sex-related differences. Methods: In this prospective cohort study, a total of 3201 participants (mean age: 22.08 years, 59.9% women) were analyzed over a 17-year period. Relative risks (RRs) with 95% confidence intervals (CIs) were calculated to evaluate the impact of night shift work on cardiometabolic health outcomes, including obesity, hyperlipidemia, hypertension, type 2 diabetes, and metabolic syndrome (MetS). Results: At Wave V, 74.7% of participants were diagnosed with overweight/obesity, 51.8% with abdominal obesity, 15.5% with hyperlipidemia, 29.1% with hypertension, 8.3% with type 2 diabetes, and 20.9% with MetS. Night shift work was associated with an increased risk of obesity and abdominal obesity in women (RR = 1.99, 95% CI: 1.08 to 3.65 and RR = 1.60, 95% CI: 1.07 to 2.56, respectively) but not in men. Women also showed an elevated risk of diabetes (RR = 2.69, 95% CI: 1.49 to 4.86), whereas no significant relationship was identified in men. Night shift work was not significantly associated with hypertension and MetS in either men or women. Conclusion Women working night shifts may benefit from targeted interventions for cardiometabolic health, particularly in managing weight and preventing diabetes, while men did not exhibit similar associations.