OBJECTIVES: To examine the role of energy intake and dietary patterns in childhood and throughout adulthood on subsequent mammographic density. METHODS: Prospective data were available from a cohort of 1161 British women followed up since their birth in 1946. Dietary intakes at age 4 years were determined by 24-hour recalls and during adulthood, average food consumed at ages 36 and 43 years by 5-day food records. Dietary patterns were determined by factor analysis. Associations between energy intake, dietary patterns, and percent breast density were investigated using regression analysis. RESULTS: During adulthood, energy intake was positively associated with percent breast density (adjusted regression coefficient [per SD) (95% CI): 0.12 (0.01, 0.23)]. The effect of the high fat and sugar dietary pattern remained similar when adjusted for total energy intake [0.06 (-0.01, 0.13)]. There was no evidence of an associations for the patterns low fat, high fiber pattern 0.03 (-0.04, 0.11); the alcohol and fish -0.02 (-0.13, 0.17); meat, potatoes, and vegetables -0.03 (-0.10, 0.04). No association was found for dietary pattern at age 4 and percent breast density. CONCLUSIONS: This study supports the hypothesis that overall energy intake during middle life is a determinant of subsequent mammographic breast density measured 15 years later.