The study evaluated the association between nutrient patterns and body fat and regional adiposity in middle-aged black South African (SA) men and women and determined if this differed by sex. Body fat and regional adiposity (dual-energy x-ray absorptiometry), and dietary intake (7-day quantified food frequency questionnaire) were measured in black SA men (n=414) and women (n=346). Using principal component analysis, nutrient patterns were computed from 25 nutrients in the combined sample. Four nutrient patterns were extracted, explaining 67% of the variance in nutrient intake. Animal and fat, as well as the vitamin C, sugar and potassium driven patterns, were positively associated with total adiposity. In contrast, the retinol and vitamin B12 pattern was associated with the centralisation of fat. Notably, the strength of the association between the animal-driven nutrient pattern and BMI was greater in men (1.14 kg/m2, 95%CI (0.63-1.66)) than women (0.81 kg/m2, 95%CI (0.25-1.36)) (Pint=0.017). In contrast, the plant driven pattern was associated with higher abdominal subcutaneous adipose tissue (SAT) in women (44 cm2, 95%CI (22-67)) but not men (Pint =1.54 x 10-4). These interactions suggest that although men and women have similar nutrient patterns, the associations with the whole body and regional body fat are different.