Purpose <p>This study examined the association between appetitive trait profiles and dietary patterns from childhood to early adolescence.</p> Methods <p>We included 5040 participants from the Generation XXI cohort (Porto, Portugal). Appetitive traits were assessed at ages 7, 10, and 13 with the validated Children’s Eating Behaviour Questionnaire. Six trajectory-based profiles were previously identified: “Smallest appetite”, “Small appetite but increasing”, “Small to moderate appetite”, “Moderate appetite”, “Increasing appetite”, and “Avid appetite”. A validated Food Frequency Questionnaire collected dietary intake at ages 4, 7, 10, and 13. Latent class analyses identified dietary patterns at each age and dietary patterns trajectories across childhood. Multinomial logistic regression assessed the association of appetitive trait profiles and dietary patterns.</p> Results <p>Three dietary patterns (“Healthier”, “Lower Consumption”, and “Energy-Dense Foods” (EDF)) and two trajectories from 4 to 13 years (“Predominantly Healthier” and “Predominantly EDF”) were identified. Compared with the “Moderate appetite” profile, children in the “Small appetite but increasing” (characterised by food avoidance and high Desire to Drink) had 54% higher odds of the “Predominantly EDF” trajectory. Conversely, individuals in the “Small to moderate appetite” profile (lowest food approach and emotional eating, suggestive of better appetite regulation) and “Avid appetite” profile were less likely to follow the “Predominantly EDF” trajectory.</p> Conclusions <p>Appetitive trait profiles are linked to dietary patterns from childhood to adolescence. Food avoidance combined with a high Desire to Drink predicted less healthy diets, while stronger food approach traits and a profile indicative of improved appetite regulation were linked to healthier dietary choices.</p>