ObjectivePrevious studies have explored the relationship of food-away-from-home (FAFH) with metabolic diseases, including obesity, diabetes, etc. However, the association between the frequency of FAFH and dyslipidemia remained unclear, especially for rural populations. This study aimed to explore the relationship of FAFH frequency with serum lipid levels and dyslipidemia in rural Chinese adults.MethodsA total of 29,479 adults aged 18–79 were recruited from the Henan Rural Cohort Study. Information on FAFH frequency was collected using a validated questionnaire. Serum total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were measured by the enzymatic method. Multiple linear regression and logistic regression models were used to explore the association of FAFH frequency with serum lipid levels and dyslipidemia, respectively. Mediation analysis was used to explore whether BMI mediated the relationship between FAFH and dyslipidemia.ResultsFAFH frequency was significantly associated with higher levels of TC, TG, LDL-C, and lower HDL-C (P < 0.05). Compared with the 0 FAFH times/week group, the multivariate odds ratios (OR) and 95% confidence interval (95% CI) of the groups with 8–11 FAFH times/week for dyslipidemia were 1.991 (1.569, 2.526) in men, and those who consumed 8–11 FAFH times/week was significantly associated with high TC (OR: 1.928, 95% CI: 1.247, 2.980), high TG (OR: 1.723, 95% CI: 1.321, 2.247) and high LDL-C (OR: 1.875, 95% CI: 1.215, 2.893), while positively associated with low HDL-C (OR: 1.513, 95% CI: 1.168, 1.959). In addition, BMI played a fully mediating role between FAFH and dyslipidemia in men.ConclusionFAFH was significantly associated with a higher risk of dyslipidemia and increased risk of abnormal serum lipid levels in rural China, especially in men. The relationship between FAFH and dyslipidemia was fully mediated by BMI in men. The findings provide new evidence for improving dietary quality and preventing dyslipidemia, especially in low- and middle-income settings.Clinical Trial RegistrationThe Henan Rural Cohort Study has been registered at the Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699).