Objective: To analyze the association between food intake and the serum total cholesterol(TC) level in adult Chinese population. Methods: This study included apparent healthy residents aged between 20 and 70 years who participated in the eighth round of China Health and Nutrition Study (CHNS) in 9 regions of China including Liaoning, Helongjiang, Shandong, Jiangsu, Henan, Hunan, Hubei, Guizhou provinces and Guangxi Zhuang Autonomous Region in 2009. The association between the serum TC level and the diet and other related factors were analyzed. Results: (1) Linear trend test showed that age, body mass index, waist circumference, systolic and diastolic blood pressure were positively related with serum TC level in 20-45 and 46-70 years old male and female (all P<0.01), while physical activity level was negatively related with serum TC level in 20-45 and 46-70 years old male and 46-70 years old female (all P<0.01). (2) Multivariate linear regression analysis showed that livestock meat intake was positively related with serum TC level in following populations: 20-45 years old male, β=0.133, P<0.001; 46-70 years old male, β=0.102, P=0.001; 20-45 years old male, β=0.065, P=0.041; years old female, β=0.059, P=0.045. Vegetable oil intake was negatively related with serum TC level in 20-45 years old male (β=-0.071, P=0.021). Saturated fat intake was positively related with serum TC level in 46-70 years old female (β=0.084, P=0.019). Total dietary cholesterol intake was positively related with serum TC level in male (20-45 years old, β=0.067, P=0.021; 46-70 years old, β=0.070, P=0.012), but not in female (20-45 years old, β=0.007, P=0.809; 46-70 years old, β=0.038, P=0.144). Cholesterol intake from livestock meat was positively related with serum TC level in male (20-45 years old, β=0.156, P<0.001; 46-70 years old, β=0.099, P=0.001), and positively related with serum TC level in 46-70 years old female (β=0.063, P=0.028). Cholesterol intake from egg was positively related with serum TC level in 46-70 years old male (β=0.056, P=0.032). Conclusions Age, body mass index, waist circumference, blood pressure, blood pressure, and physical activity level are related with serum TC level. Cholesterol intake from livestock meat was the main food source that related with serum TC level, and the serum TC increases at a relatively small level after intake of total dietary cholesterol.