This study aimed to identify major dietary patterns associated with abdominal obesity in middle-aged and older Korean adults. Data from the Korean Genome and Epidemiology Study were used. A total of 48,037 Korean adults aged ≥40 years without abdominal obesity at baseline were followed-up. Dietary assessment was conducted using a validated 106-item food-frequency questionnaire, and dietary patterns were identified using factor analysis. Abdominal obesity was defined as a waist circumference of ≥90 cm for men and ≥85 cm for women, according to the Korean Society for the Study of Obesity. Multivariable Cox proportional-hazards models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the future risk of abdominal obesity for each dietary pattern after adjusting for potential covariates. After an average follow-up of 4.89 years, we reported 5878 cases (1932 men and 3946 women) of abdominal obesity. Based on factor analysis, three major dietary patterns were identified in both men and women: the “healthy”, “coffee and sweets”, and “multi-grain” patterns. In the fully adjusted model, the “healthy” pattern was inversely associated with the incidence of abdominal obesity (HR for fourth vs. first quartile: 0.86; 95% CI: 0.75–0.98;pfor trend = 0.0358 for men; HR for fourth vs. first quartile: 0.90; 95% CI: 0.83–0.99;pfor trend = 0.0188 for women), whereas the “coffee and sweets” pattern was positively associated with it (HR for fourth vs. first quartile: 1.23; 95% CI: 1.08–1.40;pfor trend = 0.0495 for men; HR for fourth vs. first quartile: 1.14; 95% CI: 1.04–1.25;pfor trend = 0.0096 for women). In contrast, the “multi-grain” pattern in men and women showed no significant association with the incidence of abdominal obesity. Diets rich in colorful vegetables, seaweeds, mushrooms, tubers, fruits, soy products, and fish and low in coffee, sweets, and oils/fats might be favorable for reducing the future risk of abdominal obesity, particularly in middle-aged and older Korean adults.