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Aim: The purpose of this study was to investigate the association of dietary patterns with the risk of insulin resistance (IR), diabetes mellitus (DM), and central obesity in China. Methods: We performed a cross-sectional study on 1432 participants, aged 40–65 years in Hangzhou, Zhejiang province, China. Dietary intake was assessed using a semi-quantitative food frequency questionnaire. Results: Factor analysis extracted four major dietary patterns: vegetable-fruits, rice–meat, seafood–eggs, and sweet–fast. The vegetable-fruits pattern was inversely associated with HOMA-IR (p < 0.001 in both genders), while sweet–fast food pattern was significantly associated with higher HOMA-IR (p = 0.002 in male, and p < 0.001 in female). The vegetables–fruits pattern was inversely correlated with visceral fat area (VFA) (p = 0.029 in males, and p = 0.017 in females), while sweet–fast food pattern presented a significant direct association (p < 0.001 in male) with VFA in males. There was no association observed between the rice–meat pattern or the seafood–eggs pattern and HOMA-IR or VFA. After adjustment for potential confounding factors, participants in the highest tertile of vegetable-fruits pattern showed a significantly lower risk of DM in both males and females (OR: 0.30, 95% CI: 0.13–0.70 in male, and OR: 0.28, 95% CI: 0.11–0.72 in female), and lower risk of central obesity was observed in males (OR: 0.50, 95% CI: 0.29–0.86 in male). Conversely, participants in the highest tertile of sweet–fast food pattern had higher risk of DM (OR: 2.58, 95% CI: 1.23–5.88 in male), and central obesity (OR: 2.85, 95% CI: 1.67–4.86 in male) only in male. While neither the rice–meat pattern nor the seafood–eggs pattern showed significant association with DM or central obesity in both genders. Conclusions: Our findings indicated low risk of IR, DM, and central obesity with vegetable-fruits pattern while inverse relation with sweet–fast food pattern. [ABSTRACT FROM AUTHOR]