BACKGROUND: Diabetes prevalence in China is significant, with a large proportion in the prediabetes stage. Dyslipidemia is associated with abnormal glucose metabolism, and the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) shows potential in diabetes risk assessment, but its role in prediabetes progression is understudied. METHODS: A longitudinal study from 2011 to 2015 using CHARLS data was conducted. After exclusions, 1408 participants were included. NHHR was calculated from serum TC and HDL - C levels. Diabetes and prediabetes were defined based on standard criteria. Covariates and mediators were assessed, and statistical analyses included logistic regression and mediation analysis, and mediation analysis was conducted to evaluate the involvement of BMI in the association between NHHR and the risk of prediabetes progression. RESULTS: Among the 1423 people in the cohort analysis, 339 (23.8%) were diagnosed with prediabetes progression. The median NHHR was significantly larger in the progression group (136.99 vs. 124.95, p <
0.05). In the fully adjusted model, NHHR one-unitincrease led to a 10% higher risk. Subgroup analyses showed consistent associations in most subgroups. BMI mediated 33.8% of the NHHR - prediabetes progression association. CONCLUSION: NHHR is correlated with the risk of prediabetes progressing to diabetes, and BMI may mediate this association. NHHR monitoring could help assess the risk of progression in prediabetes participants.