Blood and urine cadmium levels have been found to be positively associated with hyperuricemia (HU) in some studies. Few studies have examined the association between dietary cadmium intake, dietary patterns and HU in the Chinese population. The study analysed data from 8429 adults who participated in the China Health and Nutrition Survey (CHNS). Dietary intake was assessed by 3-day 24 h food record in seven waves of survey (1991, 1993, 1997, 2000, 2004, 2006 and 2009). Serum uric acid was measured in 2009. Dietary pattern was identified using factor analysis. The association between cumulative dietary cadmium intake, dietary patterns and HU was assessed using logistic regression. In total, 1737 (16.3%) participants had HU in the study sample. After adjusting for demographic, lifestyle factors (i.e. smoking, alcohol drinking, physical activity) and chronic conditions, the OR for HU was 2.25 (95%CI 1.84–2.77, p for trend < 0.001) for extreme quartiles of estimated cumulative cadmium intake. A traditional southern dietary pattern characterized by high intake of rice, pork, fish and vegetables, and low intake of wheat was associated with three times increased prevalence of HU; comparing the extreme quartiles, the odds ratio (OR) was 3.24 (95%CI 2.61–4.01). No association between the modern dietary pattern (high intake of fruit, soymilk, egg, milk and deep fried products) and HU was found. In conclusion, traditional southern dietary pattern and cadmium intake are positively associated with hyperuricemia among Chinese adults.