Background: Cardiovascular disease remains a leading cause of mortality worldwide, and unhealthy diet, physical inactivity, excess body weight, central obesity, and metabolic alterations during young adulthood may increase cardiovascular risk later in life. In addition to conventional lipid parameters, the triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C), total cholesterol-to-high-density lipoprotein cholesterol (TC/HDL-C), and low-density lipoprotein cholesterol-to-high-density lipoprotein cholesterol (LDL-C/HDL-C) ratios have been investigated as additional indicators of alterations in lipid metabolism and atherogenic risk. Although lipid parameters and metabolic risk factors have been investigated among university students in Mongolia, assessment of metabolic risk among nursing students is of practical importance because of the characteristics of their future professional roles. This provided the rationale for the present study. Aim: To determine peripheral blood lipid ratios among students of the School of Nursing, Mongolian National University of Medical Sciences (MNUMS), and assess their associations with selected metabolic risk factors. Materials and Methods: An analytical cross-sectional study was conducted among 98 first- to fourth-year students aged 18–24 years. Data were collected using a 33-item structured questionnaire, anthropometric measurements, blood pressure measurements, and peripheral blood biochemical testing. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and glucose were measured using a Sinocare portable analyzer, and TG/HDL-C, TC/HDL-C, and LDL-C/HDL-C ratios were calculated. Body mass index (BMI), waist circumference, and systolic and diastolic blood pressure were measured using standardized procedures. Differences between groups were assessed using the Mann–Whitney U and Kruskal–Wallis tests, and associations between variables were evaluated using Spearman’s correlation analysis. A p-value <0.05 was considered statistically significant. Results: The mean age of the participants was 20.85±1.52 years, and 75.5% were female. Mean TC, TG, HDL-C, and LDL-C levels were 3.69±0.75, 1.17±0.67, 1.24±0.38, and 2.00±0.65 mmol/L, respectively. Mean TG/HDL-C, TC/HDL-C, and LDL-C/HDL-C ratios were 1.06±0.92, 3.28±0.87, and 1.80±0.66, respectively. Mean BMI was 22.93±4.11 kg/m², waist circumference was 75.96±11.28 cm, glucose was 5.63±0.72 mmol/L, and systolic and diastolic blood pressure were 113.31±9.88 and 70.72±8.49 mmHg, respectively. The TG/HDL-C ratio was positively correlated with BMI (rₛ=0.336), waist circumference (rₛ=0.381), glucose (rₛ=0.278), systolic blood pressure (rₛ=0.294), and diastolic blood pressure (rₛ=0.322). The TC/HDL-C ratio was significantly associated with BMI, waist circumference, and systolic and diastolic blood pressure, whereas the LDL-C/HDL-C ratio was significantly associated with waist circumference and systolic blood pressure. Waist circumference was significantly associated with all three lipid ratios, with the strongest correlation observed for TC/HDL-C (rₛ=0.485, p<0.001). Conclusion BMI, waist circumference, glucose, and selected blood pressure measures were positively associated with lipid ratios among the study participants. In particular, waist circumference was significantly associated with all three lipid ratios: TG/HDL-C, TC/HDL-C, and LDL-C/HDL-C. These findings indicate the importance of considering waist circumference and lipid parameters in addition to BMI when assessing metabolic risk among university students.