Objective: To explore the dietary patterns and related factors among urban middle school students in Guangzhou, and to provide the scientific reference for conducting nutritional education and intervention among the middle school students. Methods: Questionnaire survey was conducted for students in two grades (grade 1 of 27 junior and senior high schools) and their parents along with the physical examination for urban primary and secondary school students in Guangzhou. Dietary patterns were established by exploratory factor analysis. Multinomial Logistic regression model was used for analyzing influencing factors of dietary pattern. Results: Three major dietary patterns were identified. Type I (37.09%) was a healthy dietary pattern; type II (33.37%) and III (29.54%) were classified into western dietary patterns. Multinomial Logistic regression models showed that living on campus (ORⅡ=1.57, 95%CI:1.33-1.85; ORⅢ=1.28, 95%CI:1.07-1.52), screen time≥2 h/d (ORⅡ=2.89, 95%CI:2.51-3.33; ORⅢ=2.14, 95%CI:1.85-2.48) were positively associated with type II and III. The monthly household income per capita≥5 000 yuan (ORⅢ=1.31, 95%CI:1.14-1.51) was positively associated with type III. Senior students (ORⅡ=0.83, 95%CI:0.73-0.95; ORⅢ=0.74, 95%CI:0.64-0.85), the level of parental education (ORⅡ=0.64, 95%CI:0.52-0.79; ORⅡ=0.67, 95%CI:0.54-0.82; ORⅢ=0.72, 95%CI:0.58-0.90; ORⅢ=0.73, 95%CI:0.59-0.89) had a negative association with type II and III. Conclusion There are three dietary patterns among urban middle school students in Guangzhou. The main influencing factors include parental education, screen time, grade, resident situation, and monthly household income per capita.