Nutrition and Chronic Disease Management for the Clinical Endocrinologist: Leveraging the Malnutrition-Based Chronic...

This paper is based on the Keynote Address at the 2026 American Association of Clinical Endocrinology (AACE) Annual Meeting on Nutrition and Chronic Disease. Nutrition is the interaction of diet and metabolism though conventional focus is on the dietary aspect. When applied, the driver-based chronic disease paradigm re-interprets abnormal nutrition as a portfolio of preventable metabolic disorders. This paradigm comprises network analysis, key mechanistic drivers, staged progression, nonbiological factors, and early/sustainable prevention. To this end, the conceptualization, operationalization, and empirical implementation/validation of the malnutrition-based chronic disease (MBCD) model address the triple burden of undernutrition (starvation, cachexia, and other wasting syndromes) + overnutrition (eg, overweight/obesity, ectopic fat, insulin resistance, and cardiometabolic risks) + micronutrient derangements (deficiencies and toxicities). The MBCD model and critical role of structured lifestyle medicine centers on nutrition as an early and sustainable strategy to prevent chronic disease complications, disability, and higher cost-/risk-related interventions, while also promoting health (optimal and personalized metrics, low symptom burden, and happiness) and disambiguating a historically confusing lexicon. The MBCD model also addresses personalization by incorporating structural, social, and cultural determinants of health, thus expanding the range of available preventive care targets. Ultimately, the deliverable of this approach is through iterative optimization to close research, knowledge, and practice gaps. This new paradigm finds its roots in the legacy of AACE white papers that have emphasized nutrition-oriented pathophysiology in chronic disease states such as diabetes and obesity. Indeed, AACE is poised to transform nutritional medicine and endocrine care of chronic disease to tackle current contemporary healthcare imperatives on a global scale.