Objective To prospectively examine the associations between zinc intake, the zinc to heme iron ratio and the incidence of hyperglycemia in Chinese. Methods We followed 1056 healthy adults aged 20 and older from 2002 to 2007. Dietary data were collected using 3-day food record and food frequency questionnaire. Hyperglycemia was defined as fasting plasma glucose >5.6 mmol/l. Results During the 5 years of follow-up, we documented 125 incident cases of hyperglycemia. Zinc intake alone was not associated with the risk of hyperglycemia. The zinc to heme iron ratio was inversely associated with the risk of hyperglycemia: odds ratios (OR, 95% CI) across increasing quartiles of the zinc to heme iron ratio were 1.00, 0.78(0.44–1.37), 0.40(0.19–0.83), and 0.21(0.08–0.54)(p for trend= 0.001). Adjustment for lifestyle covariates did not significantly change the associations. Conclusions This cohort study suggests that the zinc to heme iron intake ratio was significantly associated with a decreased risk of hyperglycemia in Chinese adults. ; Zumin Shi, B. Yuan, L. Qi, Y. Dai, H. Zuo and M. Zhou