The objective of this study was to document the effects of different C/N ratios on inorganic nitrogen control and the growth and health of tilapia (Oreochromis niloticus) fingerlings reared in biofloc systems. The fish (0.50 ± 0.02 g) were randomly assigned to the control group (clear water) or to one of three biofloc groups (added glucose) with a C/N ratio of 10, 15, or 20 (CN‐10, CN‐15, or CN‐20, respectively). All four groups were cultured for 120 days. The inorganic nitrogen dynamics showed that heterotrophic and autotrophic bacteria existed in the low C/N ratio group, and heterotrophic bacteria dominated the high C/N ratio group. In addition, growth was significantly better in the CN‐10 and CN‐15 groups (15.67 ± 0.78 g and 14.75 ± 0.54 g, respectively) compared to the CN‐20 (13.04 ± 0.94 g) and control (13.04 ± 0.46 g) groups (p < .05). Activities of the digestive enzymes lipase and trypsin were significantly higher in the CN‐10 and CN‐15 groups than in the control group (p < .05). In addition, activities of lysozyme, alkaline phosphatase, superoxide dismutase, glutathione and malondialdehyde were significantly higher in the CN‐10 and CN‐15 groups than in the control group (p < .05). Finally, the concentrations of glucose and cortisol in the biofloc systems were significantly lower than those in the control group (p < .05). However, the concentrations of triglyceride, aspartate transaminase and alanine aminotransferase did not differ significantly among the four groups (p > .05). At the end of the trial, an acute crowding and hypoxia stress test performed for 3 days showed that the CN‐10 and CN‐15 groups had the best survival.