In lean MASLD with sarcopenia or visceral adiposity despite normal BMI, how do you prioritize resistance training/nutrition versus pharmacologic cardiometabolic prevention, and what metrics do you track to decide if the plan is working?

I don't think this is a dichotomous choice, as resistance training and nutrition are complementary to pharmacologic cardiometabolic prevention. From a pharmacologic perspective, I would be cautious with incretin-based therapies as these may worsen sarcopenia, especially in an already lean (i.e., normal body mass index [BMI]) patient. There are a number of tools to support patients for nutrition and exercise that can be found here: Abbas et al., PMID 36066462. I find it can be helpful to write a "prescription" for exercise - 30 minutes a day, 5 days a week, or place a physical therapy referral for some patients. For older patients in the U.S. with Medicare, Silver Sneakers has been a helpful resource as well. Metrics to follow can include so...