Association Between Physical Activity and Adherence to Nutritional Recommendations in Individuals with Diabetes: Analysis of Self-Reported Data from the 2020 European Health Survey in Spain

<b>Background/Objectives:</b> This study compares dietary and physical activity (PA) habits between Spanish adults with and without diabetes and analyzes the association between PA, sociodemographic variables, and adherence to nutritional recommendations among individuals with diabetes. <b>Methods:</b> A cross-sectional case-control study was conducted using data from the 2020 European Health Survey for Spain (EESE). Diabetes and PA levels were self-reported. Each participant with diabetes was matched with a control without diabetes by age, gender, and region of residence. Food intake was assessed using a food frequency questionnaire, and adherence to nutritional guidelines was evaluated based on the recommendations of the Spanish Agency for Food Safety and Nutrition. The PA levels were classified as "sedentary/low" or "moderate/high". <b>Results:</b> A total of 2053 matched pairs were analyzed. The participants with diabetes adhered to significantly more nutritional recommendations than those without diabetes (6.19 vs. 5.30; <i>p</i> < 0.001). However, 88.6% of the individuals with diabetes reported sedentary or low PA levels. Among those with diabetes, women showed better adherence to nutritional recommendations, while men reported higher PA levels. Moderate/high PA was associated with greater adherence to nutritional recommendations (OR 1.991; 95% CI: 1.201-3.146). Older age was also positively associated with adherence. <b>Conclusions:</b> Although individuals with diabetes demonstrated better adherence to nutritional recommendations than controls, most reported low PA levels. Higher PA levels, female gender, and older age were linked to greater adherence to nutritional recommendations among people with diabetes. However, the use of self-reported data made it impossible to judge whether the participants under- or over-reported their PA levels and diabetes status. Public health strategies should aim to promote both PA and healthy eating habits in this population.