In recent decades there has been an increased interest in the Mediterranean diet’s (MedDiet) protective capacity against age-related diseases. The MedDiet is comprised of wholefoods, with moderate to high dietary fat and a kilojoule intake of approximately 9,300kJ(1). The Mediterranean Diet Adherence Screener (MEDAS) has allowed for rapid assessment of MedDiet adherence across intervention and cohort studies globally(2). However, well-established reductions in older adults’ energy requirements often present a barrier to full MedDiet adherence(3,4). We sought to create an energy-adjusted MEDAS (E-MEDAS) for use in populations with reduced energy requirements, with a secondary analysis to determine that the strength of the relationship between E-MEDAS adherence and cardiometabolic biomarkers is not diminished through energy-adjustment. Baseline data from independently living, 60–90 year old participants enrolled in the MedWalk clinical trial were used. Estimated energy requirements (EER) were calculated for all participants (n = 161) using gender and age specific Schofield Equations, multiplied by a physical activity level (PAL) we derived from a novel method to calculate PAL’s from Actigraph and IPAQ-E data. Three distinct energy categories of E-MEDAS criteria were identified, with evenly reduced cutoff criteria across all food components. Participants with a completed MEDAS (n = 157) had their MedDiet adherence re-scored according to the reduced criteria cutoffs. Spearman’s rank correlation coefficient analyses, with 95% confidence intervals constructed by accelerated bias-corrected bootstrapping, were used to determine the strength and direction of association between both MEDAS and E-MEDAS adherence scores and 8 cardiometabolic biomarkers. The newly calculated E-MEDAS categories included Category 3 (corresponding to the original MEDAS) with a range of 9100–10500kJ (n = 30), Category 2 with a range of 7700–9100kJ (n = 81) and Category 1 with a range of 6300–7700kJ (n = 44). There was a significant (p < 0.05) weak negative correlation between the re-scored E-MEDAS and 5 cardiometabolic biomarkers; BMI (rs = −0.228, BCa 95% CI [−0.388, −0.074]), WHR (rs = −0.189, BCa 95% CI [−0.352, −0.027]), LDL (rs = −0.174, BCa 95% CI [−0.347, 0.009]), Total:HDL Ratio (rs = −0.288, BCa 95% CI [−0.429, −0.127]), Trigs (rs = −0.235, BCa 95% CI [−0.373, −0.079]. In contrast, the original MEDAS score resulted in a significant (p < 0.05) weak negative correlation in only 3 cardiometabolic biomarkers; WHR (rs = −0.167, BCa 95% CI [−0.317, −0.011]), Total:HDL Ratio (rs = −0.205, BCa 95% CI [−0.354, −0.049], and Trigs (rs = −0.217, BCa 95% CI [−0.360, −0.054]). Ultimately, we have successfully developed two categories of E-MEDAS, using a novel calculation of PALs, for use in individuals with reduced EERs. E-MEDAS scores showed a modest increase in the strength of relationship with five cardiometabolic biomarkers, indicating that reducing serves of individual components, while maintaining the overall dietary pattern does not negate the protective capacity of a MedDiet.