Abstract: Objective To analyze the relationship between serum low high-density lipoprotein cholesterol(HDL-c) and dietary intake among Chinese middle-aged and older adults. Methods Data were collected from Chinese Nutrition and Health Surveillance in 2010-2012. A total of 28 092 participants aged 45y and older were collected in 150 surveillance sites of urban and rural in China. Questionnaire on general information and consecutive three days 24-hour dietary survey was conducted by qualified staff. Fasting serum HDL-c was tested by direct method and low HDL-c was evaluated by Guidelines on Prevention and Treatment of Blood Lipid Abnormality in Chinese Adults 2016 revised edition. Results The total prevalence of serum low HDL-c in male middle-aged and older adults was more than that in female (χ²=202.144, P<0.001).The prevalence of low HDL-c decreased with age (χ²=9.782, P=0.002) while increased with family average income (χ²=16.143, P<0.001) and educational levels (χ²=95.129, P<0.001). The difference among four regional types was significant (χ²=7.314, P=0.007), which was 36.5% in big city, 32.4% in small and medium-sized city, 33.5% in ordinary rural areas and 34.0% in poverty rural areas respectively. Among male participants with low HDL-c and normal HDL-c, difference of dietary fruit intake, eggs intake and milk intake were statistically significant both in urban and rural areas (all P<0.05). When comparing the dietary intake difference between low HDL-c and normal HDL-c among female participants, difference of red meats intake and poultry intake were significant both in urban and rural areas (all P<0.05). Logistic regression by adjustment of confounding factors showed that cereals, fruits and red meats were associated with low HDL-c, their OR and 95% CI were 1.06(1.03-1.09), 1.12(1.06-1.19) and 0.91(0.89-0.93). Conclusions The low HDL-c prevalence was high among middle-aged and older adults both in urban and rural areas of China; low HDL-c was related with cereals, fruits and red meats consumption.