Objective This study aimed to evaluate the nutritional knowledge-attitude-practice （KAP）， dietary status， dietary pattern， and physical fitness levels of freshmen in a medical university in Guangxi Zhuang Autonomous Region， and explore the relationship between nutritional knowledge， dietary pattern， and physical fitness level， to provide a reference for the healthy dietary education of university students.Methods From May in， 2021， 2 125 freshmen from a medical university in Guangxi Zhuang Autonomous Region were surveyed using a nutritional KAP questionnaire， food frequency questionnaire， and physical fitness tests. Factor analysis was used to establish the dietary pattern of freshmen， and Pearson correlation analysis and Logistic regression analysis were conducted to analyze the correlation between dietary pattern and the total score of physical fitness test and each item. Simultaneously， descriptive analysis was conducted to analyze the nutritional KAP score， total energy， and average intake of each nutrient. A chi-square test was used to compare the differences in the distribution of nutritional behaviors among different physical test scores.Results The intake of carbohydrate， vitamin A， calcium， dietary fiber， and other nutrients of freshmen was insufficient. Pearson correlation analysis showed that the “healthy diet” pattern （r = 0.064，P < 0.01） and the “aquatic product， livestock， and poultry meat” pattern （r = 0.062，P < 0.01）were significantly positively correlated with the physical test scores. A significant negative correlation was observed between the “fried and sweet food” pattern （r = -0.057， P = 0.01）. The scores of nutrition knowledge， attitude， and practice of freshmen were 14.54 ± 2.63， 24.60 ± 3.73， and 15.61 ± 2.51， respectively. A significant difference was observed in the distribution of the breakfast eating behavior between the students who passed the physical test and those who failed it （χ² = 9.05，P < 0.05）. Binary logistic regression analysis showed that the “aquatic product， livestock， and poultry meat” pattern was significantly negatively correlated with the risk of failing the physical test in boys （OR = 0.35，95% CI = 0.14-0.91） and girls （OR = 0.41，95% CI = 0.19-0.87）， and the “preserved food” pattern was significantly positively correlated with the risk of failing the physical test in girls （OR = 2.21，95% CI = 1.15-4.27）.Conclusion The dietary structure of the freshmen in a medical university in Guangxi Zhuang Autonomous Region is not reasonable， and their nutritional knowledge level does not match their nutritional behavior. Therefore， targeted nutritional education intervention should be performed according to the characteristics of the freshmen， so as to gradually develop healthy eating habits and improve their physical level.