Natália Alvarenga Borges, Ludmila Ferreira Medeiros de França Cardozo, Viviane de Oliveira Leal, Letícia de Sá Fernandes Vallim da Silva, Donald Wesson, Denis Fouque, Denise Mafra
The rapid expansion of pharmacological therapies for obesity, type 2 diabetes, and chronic kidney disease (CKD) has transformed clinical practice and broadened the therapeutic landscape for the management of metabolic diseases. These agents provide well-established cardiometabolic and renal benefits; however, their use should be understood within the context of an integrated approach, alongside interventions targeting lifestyle-related determinants of disease. Lifestyle-related factors, including dietary patterns and physical activity, remain central to the pathophysiology of metabolic diseases and CKD. At the same time, pharmacological modulation of metabolic pathways offers targeted therapeutic benefits, particularly in individuals at higher risk. Nutritional and pharmacological strategies act through complementary mechanisms and may provide synergistic effects when implemented concurrently and individualized according to clinical risk. Dietary interventions, particularly those rich in minimally processed foods and bioactive compounds, exert pleiotropic effects on processes such as inflammation, oxidative stress, mitochondrial dysfunction, premature aging, and gut dysbiosis, which are shared hallmarks of CKD. The growing use of pharmacological therapies in metabolic diseases and CKD highlights the importance of understanding how to integrate them with lifestyle-based strategies. Individualized therapeutic approaches that incorporate nutritional and pharmacological interventions, when indicated, may help optimize cardiometabolic and renal outcomes. Considering the chronic nature of these conditions, sustained strategies centered on diet and physical activity remain essential components for maintaining long-term metabolic and renal health.