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Understanding patterns of dietary change over time can provide important information regarding population nutrition behaviours. The aims were to investigate change in diet quality over 12 years in a nationally representative sample of women born in 1946&#8722;1951 and to identify characteristics of women whose diet quality changed over time. The Australian Recommended Food Score (ARFS) was measured in 2001 (<i>n</i> = 10,629, mean age 52.1 years) and 2013 (<i>n</i> = 9115; <i>n</i> = 8161 for both time points) for the mid-aged cohort from the Australian Longitudinal Study on Women&#8217;s Health. Participants were categorised by tertiles of baseline diet quality and also classified as &#8216;diet quality worsened&#8217; (ARFS decrease &#8804; &#8722;4 points, <i>n</i> = 2361), &#8216;remained stable&#8217; (&#8722;3 &#8804; change in ARFS &#8804; 3 points, <i>n</i> = 3077) or &#8216;improved&#8217; (ARFS increase &#8805; 4 points, <i>n</i> = 2723). On average, ARFS total and subscale scores remained relatively stable over time (mean [SD] change 0.3 [7.6] points) with some regression to the mean. Women whose diet quality worsened were more likely to be highly physically active at baseline compared with women whose diet quality improved (<i>p</i> &lt; 0.001). Among women with poor diet quality initially (lowest baseline ARFS tertile, <i>n</i> = 2451, mean [SD] baseline ARFS 22.8 [4.5] points), almost half (47%, <i>n</i> = 1148) had not improved after 12 years, with women less likely to be in the healthy weight range (41% compared to 44%) and be never smokers (56% versus 62%, <i>p</i> &lt; 0.05) compared with those whose diet improved. Diet quality remained relatively stable over 12 years&#8217; follow up among mid-aged women. Almost half of those with poor baseline diet quality remained poor over time, emphasizing the need to target high-risk groups for nutrition interventions.