Introduced in 2001, MDX was named North American Truck of the Year by a panel of 50 independent automotive journalists. Through the five model years since, the MDX has been steadily improved in all areas.

The body has grown more rigid, allowing better vibration control and a smoother ride. Power has increased, and a more compact five-speed automatic transmission shifts even more smoothly than before. The MDX's four-wheel-drive system was remapped to work seamlessly with a Vehicle Stability Assist system to improve handling on slippery surfaces and to enhance stability in all conditions. Side curtain airbags covering all three seating rows were added, as were tire pressure monitors. Front and rear end styling has been redone, with a more aggressive edginess. Acura has updated the optional navigation system and added a rearview camera that engages when the transmission is in reverse. A DVD entertainment system with wireless infrared headphones is available. XM Satellite Radio and Bluetooth capability for compatible cell phones come standard.