Previous studies have reported associations between alcohol consumption patterns and diet quality. However, this study expanded previous knowledge by investigating the relationship between alcohol consumption patterns—categorized by frequency and amount of alcohol consumption—and diet quality, assessed by using the Korean Healthy Eating Index (KHEI), among Korean adults aged 30–64 years. A total of 7885 adults (3469 men and 4416 women) from the 2019–2021 Korea National Health and Nutrition Examination Survey were included. Drinking patterns were classified based on frequency and quantity, and their association with diet quality was compared to that of abstainers. In both men and women, infrequent heavy drinkers, more frequent moderate/light drinkers, and more frequent heavy drinkers had significantly lower scores for total and fresh fruit intake, and higher scores for calories from sweets and beverages than abstainers. Among women, the odds of being in the lowest KHEI quartile (Q1) compared to the highest (Q4) were significantly higher for infrequent heavy drinkers (adjusted odds ratio [AOR] = 1.61; 95% confidence interval [CI]: 1.08–2.39), more frequent moderate/light drinkers (AOR = 1.65; 95% CI: 1.05–2.58), and more frequent heavy drinkers (AOR = 2.54; 95% CI: 1.44–4.49). These findings suggest that frequent drinking and higher intake per occasion are associated with lower consumption of fresh fruit and poorer overall diet quality. In women, both frequent drinking and high consumption during infrequent drinking occasions were more strongly associated with poor diet quality, highlighting the need for stricter dietary guidance related to alcohol consumption.
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