Background: Populations living in Mediterranean islands are experiencing a nutrition transition process from traditional to Westernized dietary patterns. No information on this matter regarding individuals living in Malta have been published to date. The aim of this study was to assess the level of adherence of the Maltese people to the Mediterranean diet and which factors were associated with it. Methods: A nationwide cross-sectional study was conducted in the island of Malta between 2014 and 2016. A literature-based Mediterranean diet adherence score was used to assess the level of adherence to the dietary pattern. Results: Out of 3947 adults, the overall Mediterranean diet adherence score mean was 7.19 (SD 1.91): being female, non-smoker, and having older age was associated with higher adherence to the Mediterranean diet. Less clear pattern of association was found for educational and occupational status, for which medium educational level and a high occupational level were associated with lower adherence to Mediterranean diet. Higher adherence was finally associated with consumption of healthier food groups (more rice and dark bread and less pasta and white bread; more all plant-food groups and fish, less animal-food sources, including fast foods; more light cheeses and yogurt were more frequently consumed among higher adherent individuals in spite of regular ones). Conclusions: Adherence to the Mediterranean diet in Malta is lower than in those of populations living in companion Mediterranean islands. Given the lack of data on this topic, further studies should be conducted among the Maltese people and public health nutrition interventions should be planned to improve current eating habits toward more traditional dietary patterns.