INTRODUCTION: Healthy dietary habits prevent childhood overweight and obesity and the risk of non-communicable diseases (NCDs) later in life. We examined dietary patterns and their association with adiposity among primary school children in northern Tanzania. METHODS: Dietary data was collected by 24-h recall and food frequency questionnaire (FFQ) for 1170 primary school children aged 9 - 11 years from 20 primary schools in the Kilimanjaro region. Factor analysis and FFQ data were used to identify dietary patterns. Children were categorized into terciles of their adherence to each dietary pattern. Multilevel logistic regression was used to evaluate the association of dietary pattern terciles with adiposity indicators: body mass index z-scores (BMI z scores), body fat percentage by bioelectrical impedance, triceps, subscapular skinfold thicknesses, and waist circumference. RESULTS: Fifteen percent of children had BMI Z > 1.0, indicating overweight or obesity. Two dietary patterns were identified by factor analysis: a healthy pattern characterized by frequent consumption of fruits and vegetables; and a mixed dietary pattern characterized by intake of fatty snacks, sweets and sugar snacks, sugary beverages, meat and alternatives, milk, and milk products. After adjusting for potential confounders, for both models: model 1 (age and sex), and model 2 (age, sex, school type, time spent walking to school, district [urban/ rural], availability of television and electronic gadgets at home and neighbourhood playground); we found no significant associations between dietary patterns and adiposity measures. CONCLUSION: Dietary patterns were not associated with adiposity in Tanzanian primary school children, possibly because of limitations of the FFQ, which did not record information on portion sizes. Future research should focus on understanding the key foods / snacks consumed by school children, portion sizes and their long-term effects on adiposity in children.