The NutrEval FMV® is both a blood and urine test that evaluates over 125 biomarkers and assesses the body's functional need for 40 antioxidants, vitamins, minerals, essential fatty acids, amino acids, digestive support, and other select nutrients. Personalized recommendations for nutrients are determined by using an algorithm based on the patient's test findings. The NutrEval Plasma and NutrEval FMV (first morning void) differ based on which sample type is used to measure amino acids, plasma or urine.
NutrEval is the most comprehensive functional and nutritional assessment available. It is designed to help practitioners identify root causes of dysfunction and provide a systems-based approach to help patients overcome chronic conditions and live a healthier life.
According to the World Health Organization, every country in the world is affected by one or more forms of malnutrition. The term malnutrition addresses 3 broad groups of conditions:1
Proper nutrition is key to preventing a number of diseases. Nutrients are necessary to feed every cell and ensure all body systems are functioning properly. Testing can help clinicians and patients gain an understanding of how nutritional imbalances may be impacting their health. Certain conditions or dietary, genetic, and lifestyle factors may predispose a person to having nutrient imbalances.
The biomarkers on the NutrEval are arranged as follows (see sample report for individual analytes):
Certain amino acids are measurable in blood versus urine and sample type selection depends on the clinical concern. The key differences between plasma and urine amino acids are summarized below.21,22
Plasma Amino Acids (Fasting) | Urine Amino Acids (First Morning Void) |
Fasting sample represents "steady state" pool of amino acids; not affected by short-term diet fluctuations | Represents recent dietary intake and metabolism - more variable compared to plasma |
36 analytes | 40 analytes |
Useful for mood disorders, or uncontrolled diets | Useful for controlled diets, to assess protein maldigestion, oxidative stress, vitamin/mineral cofactors affecting amino acid metabolism |
Amino acid levels influenced by abnormal kidney function; preferred if patient has proteinuria | Amino acid levels influenced by abnormal kidney function; urine testing dependent on healthy kidney function (biomarkers ratioed to urine creatinine) |
Requires a blood draw | Requires a urine sample |
The NutrEval FMV is one of the most comprehensive nutritional profiles available assessing a broad array of macronutrients and micronutrients, as well as markers that give insight into digestive function, toxic exposure, mitochondrial function, and oxidative stress.
Genova provides a user-friendly report with clinically actionable results including:
There are various methods of assessing nutrient status, including intracellular and extracellular direct measurement, and measuring biochemical pathway markers that require specific nutrient cofactors for proper metabolism. The NutrEval uses a combination of these methods and synthesizes the information via an algorithm that determines personalized nutrient needs. The algorithm is based on functional markers shown in the literature to be associated with a need for a particular nutrient.
Functional evaluation of nutritional status assesses metabolic intermediates produced in enzymatic pathways of cellular energy production, detoxification, neurotransmitter breakdown, and amino acid metabolism. Specific metabolites outside of reference range may signal a metabolic inhibition or block. This abnormality may be due to a nutrient deficiency, an inherited enzyme deficit, toxic build-up, or drug effect. It is possible for an individual to have normal blood levels of a vitamin in order to maintain homeostasis, while exhibiting signs of insufficiency/deficiency for that vitamin. For this reason, direct testing of individual nutrients alone does not provide a complete picture.
Other methods of assessing nutrient status, such as intracellular lymphocyte testing, has limited literature support.
Conventional nutritional panels include tests such as complete blood count, comprehensive metabolic panel, iron, ferritin and other select nutrients. The NutrEval is not meant to be a substitute for this important testing, but rather a complement by providing additional information.
Personalized recommendations for amino acids, fatty acids, vitamins, minerals, digestive support, and other nutrients are provided for each patient. Additionally, exposure to select toxic substances and oxidative stressors may need to be addressed. Comprehensive stool testing or SIBO breath testing may be appropriate to investigate the possible cause for maldigestion/malabsorption and dysbiosis.
Urinary organic and amino acids are measured via GCMS, LC/MS/MS and alkaline picrate. Fatty acids are measured via GCMS. Urinary oxidative stress markers are measured using colorimetric, thiobarbituric acid reactive substances (TBARS) and LC/MS/MS. CoQ10 is measured via HPLC. Glutathione is measured using colorimetric. Nutrient and toxic elements are measured using ICP-MS and Kinetic (Jaffe). Reference ranges are age and gender specific and are based on a questionnaire-qualified healthy cohort. Testing is not performed in patients under 2 years old.
Analyte List |
---|
1-Methylhistidine |
2-Hydroxyphenylacetic Acid |
3-Hydroxyproprionic Acid |
3-Methyl-4-OH-phenylglycol |
3-Methylhistidine |
4-Hydroxyphenylpyruvic Acid |
5-OH-Indoleacetic Acid |
8-OHdG |
Adipic Acid |
Alanine |
Alpha-amino-N-butyric acid |
Alpha-aminoadipic acid |
Anserine (dipeptide) |
Arachidic |
Arachidonic |
Arginine |
Arsenic |
Asparagine |
Aspartic acid |
Behenic |
Benzoic |
Benzoic/Hippuric Acids Ratio |
Beta-alanine |
Beta-aminoisobutyric acid |
Cadmium |
Carnosine (dipeptide) |
Cis-Aconitic Acid |
Citramalic Acid |
Citric Acid |
Citrulline |
CoQ10 |
Copper |
Creatinine |
Cystathionine |
Cysteine |
Cystine |
D-Arabinitol |
Dihomo-gamma-linolenic |
Dihydroxyphenylpropionic Acid |
Docosahexaenoic |
Docosapentaenoic |
Docosatetraenoic |
Eicosadienoic |
Eicosapentaenoic |
Elaidic |
Ethanolamine |
Formiminoglutamic Acid (FIGlu) |
Gamma-Linolenic |
Gamma-aminobutyric acid |
Glucose |
Glutamic acid |
Glutamine |
Glutaric Acid |
Glutathione |
Glyceric Acid |
Glycine |
Glycolic Acid |
Hippuric |
Histidine |
Homovanillic Acid |
Indoleacetic Acid |
Isocitric Acid |
Isoleucine |
Kynurenic Acid |
Lactic Acid |
Lead |
Leucine |
Lignoceric |
Linoleic |
Lipid Peroxides |
Lysine |
Magnesium |
Malic Acid |
Manganese |
Margaric |
Mercury |
Methionine |
Methylmalonic Acid |
Nervonic |
Oleic |
Ornithine |
Orotic Acid |
Oxalic Acid |
Palmitic |
Palmitoleic |
Pentadecanoic |
Phenylacetic Acid |
Phenylalanine |
Phosphoethanolamine |
Phosphoserine |
Potassium |
Proline |
Pyroglutamic Acid |
Pyruvic Acid |
Sarcosine |
Selenium |
Serine |
Stearic |
Suberic Acid |
Succinic Acid |
Taurine |
Threonine |
Tricosanoic |
Tryptophan |
Urea |
Vaccenic |
Valine |
Vanilmandelic Acid |
Zinc |
a-Keto-b-Methylvaleric Acid |
a-Ketoadipic Acid |
a-Ketoglutaric Acid |
a-Ketoisocaproic Acid |
a-Ketoisovaleric Acid |
a-hydroxybutyrate |
alpha-Linolenic |
b-OH-Butyric Acid |
b-OH-b-Methylglutaric Acid |
CPT Codes | |
---|---|
1-Methylhistidine | 82139 |
2-Hydroxyphenylacetic Acid | 83921 |
3-Hydroxyproprionic Acid | 83921 |
4-Hydroxyphenylpyruvic Acid | 83921 |
5-OH-Indoleacetic Acid | 83497 |
8-OHdG | 83520 |
Adipic Acid | 83921 |
Arachidic | 82542 |
Behenic | 82726 |
Cadmium | 82300 |
Citric Acid | 82507 |
CoQ10 | 82542 |
Copper | 82525 |
Creatinine | 82570 |
D-Arabinitol | 84311 |
Docosatetraenoic | 82726 |
Glutaric Acid | 83921 |
Glutathione | 82978 |
Glyceric Acid | 83945 |
Glycolic Acid | 83945 |
Homovanillic Acid | 83150 |
Isocitric Acid | 83921 |
Lactic Acid | 83605 |
Lead | 83655 |
Lignoceric | 82726 |
Lipid Peroxides | 84311 |
Magnesium | 83735 |
Malic Acid | 83921 |
Manganese | 83785 |
Methylmalonic Acid | 83921 |
Nervonic | 82726 |
Orotic Acid | 83921 |
Oxalic Acid | 83945 |
Potassium | 84132 |
Pyruvic Acid | 84210 |
Suberic Acid | 83921 |
Succinic Acid | 83921 |
Tricosanoic | 82726 |
Vanilmandelic Acid | 84585 |
Zinc | 84630 |
a-Keto-b-Methylvaleric Acid | 83921 |
a-Ketoadipic Acid | 83921 |
a-Ketoglutaric Acid | 83921 |
a-Ketoisocaproic Acid | 83921 |
a-Ketoisovaleric Acid | 83921 |
a-hydroxybutyrate | 83921 |
b-OH-Butyric Acid | 83921 |
b-OH-b-Methylglutaric Acid | 83921 |
Specimen Requirements |
---|
1 amber tube – serum (frozen); 1 blue-top Na-Heparin tube or blue-top K2-EDTA - Packed RBCs (refrigerated); 1 red-top neutral tube - serum (frozen); 1 EDTA tube 9mL - whole blood (refrigerated); 1 EDTA tube 4mL - whole blood (refrigerated); 1 green-top preservative tube - FMV urine (frozen); 1 blue-top amber tube - FMV urine (frozen); 1 green-top tube - FMV urine (frozen) |