BackgroundHookah smoking has pointedly increased worldwide and could have different harmful health effects. However, long term hookah smoking effects on chronic diseases has not been well studied. This study was aimed to investigate the relationship between hookah smoking with metabolic syndrome and diabetes.MethodsIn this prospective study, the baseline data from 3695 participant (35−70 years old) of Bandar‐e‐Kong cohort study in Hormozgan province, Iran were used. In this study, data were collected through the questionnaires designed in the Kong cohort study and 25 mm of blood sample. All analyses were performed using SPSS version 27.0 and the ggplot2 package in RStudio version 2023.06.1 + 524. p < 0.05 was considered a significant difference.ResultsThe prevalence of hookah smoking was 17.3% in total. Also, the prevalence of metabolic syndrome, diabetes, hypertension, and dyslipidemia were 35.6, 15.2, 31.2, and 78.0%, respectively. Our results showed that there were statistically significant relationship between hookah smoking and metabolic syndrome, hypertension and diabetes (p < 0.05). In the case of dyslipidemia, hookah smoking was also associated with increase in dyslipidemia (p < 0.05).ConclusionsMore evidence is needed to understand the mechanism of hookah smoking and these health effects. As well as, health education and increasing public awareness about the health effects of hookah smoking and implementation of smoking prohibition policies are highly recommended.