This study evaluated changes in diet quality during the coronavirus disease 2019 (COVID-19) pandemic and its association with variations in attitudes or behavior, as well as health status changes. Participants were Japanese adults aged 20-69 years who resided in 13 prefectures where specific cautions were announced to prevent the spread of the virus. An online survey was conducted in September 2021, and participants were those who shopped for food or prepared meals more than twice a week during the survey. Overall, 2101 participants were analyzed. An improved or worsened diet quality was determined based on changes in food consumption patterns, and participants were categorized into three groups (improved diet quality (IDQ), worsened diet quality (WDQ), and others). The IDQ group participants (10.2%) improved their dietary consciousness during COVID-19, cooked almost everything from ingredients, and increased their balanced meal eating frequency. However, the WDQ participants (11.1%) had worsened dietary consciousness and increased consumption of takeaway meals and alcohol but decreased balanced meal consumption. Cooking frequency changes were not independent determinants of variations in diet quality. Our results show that the diet quality changes during COVID-19 were possibly caused by changes in dietary consciousness or different levels of meal preparation practices.