OBJECTIVE: High water consumption has been proposed as an aid to weight control and as a means of reducing the energy density of the diet. This study examines the relationship between water consumption and other drinking and eating patterns. RESEARCH METHODS AND PROCEDURES: The National Health and Nutrition Examination Survey 1999 to 2001, with responses from 4755 individuals [>/=]18 years of age, provides the data for this cross-sectional analysis. A cluster analysis was performed using z-scores of specific food and beverage consumption to examine patterns. A multinomial logit analysis was used to examine sociodemographic characteristics of each dietary pattern and to examine the effects of water consumption on the likelihood of consuming a non-dairy caloric beverage. All results were weighted to be nationally representative and controlled for design effects. RESULTS: Within the sample, 87% consumed water, with an average daily consumption of 51.9 oz (1.53 liters) per consumer. Water consumers drank fewer soft/fruit drinks and consumed 194 fewer calories per day. Water consumers (potentially a self-selected sample) consumed more fruits, vegetables, and low- and medium-fat dairy products. Four distinct unhealthy dietary patterns were found that included little or no water consumption. Older and more educated persons used healthier food patterns. Mexican dietary patterns were much healthier than dietary patterns of blacks. DISCUSSION: Water consumption potentially is a dietary component to be promoted, but much more must be understood about its role in a healthy diet. Because high water consumption is linked with healthier eating patterns--patterns more likely to be followed by higher-educated, older adults--the target of water promotion and healthy diet options should focus on younger and less educated adults.