PURPOSE: This study was conducted to identify the predictive factors for pre-diabetes in middle-aged Korean women based on the Korean National Health and Nutrition Examination Survey (KNHANES). METHODS: In this cross-sectional study, data were extracted from the second year of the 6th KNHANES (2013~2015), conducted at 129 sites from January to December 2014. The 1,275 subjects were middle-aged women between 40 and 64 years of age characterized as “pre-diabetic†(n=618) or “normal†(n=657) according to the American Diabetes Association (ADA) standard. Multivariate binary logistic regression was used to determine factors influencing pre-diabetes in middle-aged women. RESULTS: The significant factors for pre-diabetes were a Waist-to-Height Ratio (WHtR) > 0.53 (Odds Ratio [OR]=1.71, 95% Confidence Interval [CI]=1.27~2.29), increasing prevalence of hypercholesterolemia (OR=2.02, 95% CI=1.42~2.86), and low level of High-Density Lipoprotein (HDL) cholesterol (OR=1.89, 95% CI=1.18~3.02). In addition, as age increased after 50 years, the proportion of WHtR > 0.53 decreased in the normal group, but increased with age in the pre-diabetes group. CONCLUSION: Education to raise awareness about diabetes including pre-diabetes is needed for effective management of hyperlipidemia and central obesity to ensure a healthy middle age.