Although the association between food patterns and the risk of colorectal cancer (CRC) and colorectal adenomas (CRA) has been explored previously, a distinct paucity of studies has evaluated the association of nutrient pattern and the risk of CRC and CRA as precursors of CRC. Thus, the purpose of this case-control study was to investigate nutrient patterns and their relationship with CRC and CRA in Iran. Two hundred forty hospital control, 129 newly diagnosed CRC and 130 newly diagnosed CRA patients were asked about their dietary intakes using validated questionnaires. To define the major nutrient patterns, principal component analysis was applied based on preselected nutrients, and four explainable nutrient patterns were obtained: Factor 1 (mixed), factor 2 (the antioxidant), factor 3 (dairy) and factor 4 (the high fat). Logistic regression was used to determine odds ratios (OR) with 95% confidence interval (CI) of CRC and CRA according to categories of nutrient patterns. After adjusting for confounders, factor 2 was significantly associated with lower risk for the CRC and CRA in the second category compared with the first, respectively (OR = 0.20, 95% CI: 0.12–0.34, OR = 0.34, 95% CI: 0.21–0.56). Participants in the highest category of factor 4 showed an increase in the risk of CRC and CRA, respectively, than those in the low category, in both crude and multivariate analysis (OR = 1.77, 95% CI: 1.57–2.95, OR = 1.85, 95% CI: 1.13–3.02). Among derived nutrient patterns, ‘the antioxidant pattern’ was inversely associated with CRC/CRA, whilst ‘high fat pattern’ showed a direct association with these diseases.