Considering the high prevalence of metabolic syndrome and its association with cardiovascular mortality, we prospectively evaluated the role of diet in the incidence of metabolic syndrome in renal transplant recipients. Our prospective cohort of 160 adult renal allograft recipients was followed for 1 year and had no existing metabolic syndrome or diabetes mellitus. Routine dietary intakes were assessed with food-frequency questionnaires, and metabolic syndrome was defined according to the Adult Treatment Panel III guidelines. We identified 3 major patterns by factor analysis, consisting of those recipients predominantly consuming fats and sugars, those predominantly consuming whole grain, and the Mediterranean diet. When analyzed by multivariable logistic regression and after controlling for potential confounders, subjects in the highest tertile of scores for the Mediterranean diet had a significantly lower odds of metabolic syndrome than those in the lowest tertile. Subjects in the highest tertile of scores for consuming fats and sugars had significantly greater odds of metabolic syndrome compared with those in the lowest tertile. Our study shows that the Mediterranean dietary pattern is associated with a reduced risk of metabolic syndrome in renal transplant recipients.