Cardiometabolic risks were increasing in Fukushima residents after the Great East Japan Earthquake. We examined the association between dietary patterns and cardiometabolic risks in those aged ≥16 years. Dietary patterns were derived by principal component analysis for participants who underwent at least one diet assessment using a short-form food frequency questionnaire during 2011–2013 and a health checkup in 2014 and 2015 (n = 15,409 and 14,999, respectively). In 2014, the adjusted prevalence ratio (PR) and 95% confidence interval (CI) in the highest versus lowest quartile of accumulative mean scores were 0.97 (0.96–0.99) for overweight/obesity, 0.96 (0.95–0.97) for total cholesterol (TC) ≥ 220 mg/dL, 0.96 (0.95–0.98) for low-density lipoprotein cholesterol (LDL-C) ≥ 140 mg/dL, and 0.97 (0.96–0.99) for triglycerides ≥ 150 mg/dL for a vegetable diet and 1.03 (1.01–1.04) for TC ≥ 220 mg/dL and 1.02 (1.01–1.04) for LDL-C ≥ 140 mg/dL for a juice/milk diet. In 2015, we found consistently significant associations for the vegetable and juice/milk diets, and the PR and 95% CI were 0.99 (0.98–1.00) for HDL-C < 40 mg/dL for a meat diet. The continuous promotion of the vegetable pattern diet is necessary to reduce cardiometabolic risks, particularly dyslipidemia, in Japan.