Is it really necessary to use premium fuel in a 2003 Acura MDX?
No, a 2003 Acura MDX does not require premium fuel. It's designed to run on regular unleaded gasoline. While using premium *might* offer slightly better performance or a marginally smoother running engine, it's not necessary and won't damage the car. The owner's manual should specify the recommended fuel type, and it almost certainly will say regular unleaded is fine.