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The NutrEval® is both a blood and urine profile 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 your patient's test findings. Functional pillars with a built-in scoring system guide the need for therapeutic support in areas of methylation, toxic exposure, mitochondrial dysfunction, fatty acid imbalances, and oxidative stress. The NutrEval Plasma and NutrEval FMV (first morning void) differ based on which sample type is used to measure amino acids, plasma or urine.
We also offer the Metabolomix+, a similar profile that can be collected entirely at home – no blood draw required.
According to the World Health Organization, every country in the world is affected by one or more forms of malnutrition.[1] Nutritional imbalances are often root cause contributors to disease. Correcting these imbalances can result in optimized health and well-being of your patients.
*Testing is not performed in patients under 2 years old. However, NutrEval does include reference ranges and nutrient needs that apply to pediatric patients aged 2 and older.
The NutrEval report categorizes results into several metabolic areas (see sample reports in the Support Materials 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.[25,26]
| 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 |
Genova’s unique approach to nutritional testing begins by assessing the body’s biochemical pathways. Marked accumulation of organic acids or amino acids in urine can signal a metabolic inhibition or block. The metabolic block may be due to a nutrient deficiency, an inherited enzyme deficit, toxin build-up, or drug effect. Enzymes that are responsible for metabolizing organic acids and amino acids are vitamin and mineral dependent. With this, elevations in organic acids or amino acids can reflect a functional need for these nutrients on a cellular and biochemical level, even despite normal serum levels.[27,28,29,30,31] Recommendations for nutrient supplementation based on results are generated using a literature-based proprietary algorithm.
Traditionally, urinary organic and amino acid assessment has been used in neonatal/pediatric medicine to identify genetic inborn errors of metabolism, with severity depending on the degree and type of error.* In many cases of genetic inborn errors, the enzymatic defect may be compensated for by high doses of specific vitamin and mineral cofactors and/or dietary interventions. Intervention with higher-dose nutrient cofactors may also be effective in cases of decreased enzyme activity due to causes other than frank inborn errors.
There are various methods of assessing nutrient status, including intracellular and extracellular direct measurement, and measuring biochemical pathway markers. The NutrEval utilizes all of these methods, making it the only nutritional profile of its kind.
* Genova’s organic acid testing is not intended for the diagnosis of neonatal inborn errors of metabolism.
Nutrition is powerful! A few simple tweaks can make a big difference in your body and how you feel. Nutritional testing can help you identify your unique nutritional needs.
Nutrition is important for every body system. Poor nutrition contributes to many chronic diseases. If you struggle with any of the following conditions or are curious about your nutritional status, nutritional testing may be able to help identify the root cause of your ailments:
Genova’s nutritional testing provides a more complete assessment compared to what standard labs offer. Personalized recommendations for amino acids, fatty acids, vitamins, minerals, digestive support, and other nutrients are provided. Testing can also reveal toxic exposures and measure your body’s ability to neutralize those toxins.
The benefits of nutritional balance include healthy weight, mental wellness, disease prevention, and increased energy – if you are ready to feel your best, talk with your healthcare provider about nutritional testing.
The NutrEval requires both a blood draw and a urine sample. Review the Test Preparation tab to learn more about the collection process.
Certain medications, supplements, and/or foods may impact test results. Please note that the reference ranges were established based on patients who were taking no medications or supplements. In some instances it is unknown what potential impact a medication may have on test results.
Genova never recommends that patients discontinue medically necessary medications or supplements in order to complete testing.
There may be times when a patient may stay on a medication or dietary supplement during testing in order to evaluate its effectiveness. The recommendation to discontinue any substance is intended to establish a baseline finding. While there are no rigid rules on time frames for discontinuing supplements to establish a baseline, some clinicians choose to discontinue 4 days prior to testing. If you choose to discontinue a medication, a good rule of thumb is to take the biological half-life of the drug times 5 to allow for 'clearance' before testing. With certain medications, the drug itself may have cleared the body, but the effect of the medication may be longer lasting. Below you will find a list detailing the potential interference or influence of certain substances on the biomarkers.
| Dietary Factor | Possible Impact on Results |
| Artificial sweeteners and MSG | Artificial sweeteners and MSG are composed of amino acids which can directly impact measured amino acid levels |
| Eat your usual diet; avoid over-consuming any single food, extreme diets, or engaging in a rigourous activity (i.e. marathon) | Extreme diets and activity may impact certain organic acid biomarkers related to the citric acid cycle, neurotransmitter metabolites, dysbiosis markers, or amino acids |
| Phenol and flavonoid containing compounds in fruits, vegetables, chocolate, and tea can result in elevation of certain bacterial and fungal dysiosis markers on the organic acids profile | |
| Bananas, pineapple, kiwi, plums, avacado, walnuts, and pecans can result in an elevation of the serotonin metabolite 5-HIAA measured on the organic acids profile | |
| Seafood | Seafood containing heavy metals such as mercury and arsenic can result in a transient elevation |
| Six 8-ounce glasses of fluid | Creatinine concentration is influenced by fluid intake |
| Fasting, water allowed only | Reference ranges were set based on an overnight-fasted population. Overnight fasting minimizes influence of a single meal and provides a "steady diet" sample |
Medications and supplements may impact results. The discontinuation of any medication is at the discretion of the clinician, only if medically appropriate.
| Medications and Supplements | Possible Impact on Results |
| Valproic acid | Direct assay interferent for organic acid xanthurenic acid |
| Acetaminophen | Direct assay interferent for multiple organic acids |
| Berberine HCl | Direct assay interferent for organic acids IAA and 5-HIAA |
| Antibiotics, antifungals, probiotics, digestive enzymes, acid blocking medications | May indirectly influence urinary organic acid markers of malabsorption/dysbiosis Amino acid levels may be impacted by aminoglycoside antibiotics |
| Amphetamines, centrally acting medications, antidepressants, Anti-Parkinsonian medications | May influence urinary organic acid markers of neurotransmitter metabolism1,2 |
| HMG-CoA-reductase inhibitors (statins) and red yeast rice | May indirectly increase urinary organic acid B-methylglutaric acid levels |
| N-Acetyl Cysteine (NAC) | Direct assay interferent for cholesterol and triglycerides add-on tests; may lead to falsely low results |
| Oral contraceptives, estrogen therapy | May increase the organic acid quinolinic acid excretion both from altered tryptophan metabolism directly, as well as the indirect functional vitamin B6 insufficiency3 |
| Quercetin | May elevate the organic acid homovanillic acid4 |
| Steroids | May lower inflammatory neurotransmitter metabolite quinolinic acid, an organic acid |
| Diuretics | May impact creatinine concentration, thus affecting all urinary biomarker measurements |
| Fibrates | May influence fatty acid levels In some animal studies, fibrates also impact cellular energy metabolites on the organic acids profile |
| Kreb's cycle and amino chelated supplements (i.e. citrate, malate, succinate, glycinate, threonate, and orotate forms of supplements [magnesium citrate], alpha ketoglutarate, and others) | May result in elevations of corresponding Kreb's cycle markers and amino acids |
| Provocation/chelating agents (i.e. DMPS, DMSA, EDTA, etc.) | Reference ranges are based on a non-provoked, non-chelated patient population |
| Vitamin C | May increase urinary excretion of organic acid oxalic acid or lead |
Dietary Influences on urinary organic acids:4-16
| Urinary Metabolite | Common Dietary Sources |
| Indoleacetic acid | High tryptophan intake, green/black tea |
| Phenylacetic acid | Wine/grapes |
| Dihydroxyphenylpropionic acid | Whole-grains, chocolate, coffee, green/black tea, olives/olive oil, citrus fruits (animal studies) |
| 3-Hydroxyphenylacetic acid & 4-hydroxyphenlyacetic acid |
Wine/grapes, cranberries, green/black tea, berries, orange juice, grape seed extract |
| Benzoic acid/Hippuric acid | Orange juice, elderberry, huckleberry, food preservative, berries, other flavonoids |
| Citramalic acid | Apples, cranberries, sugar beets |
| Tartaric acid | Wine/grapes, chocolate, food additive/preservative |
| Malic acid | Fruits (apples, pears), vegetables, throat lozenges, syrups, beverages with food preservatives and additives |
| Homovanillic acid | Flavanols including tomatoes, onions and tea |
| 5-hydroxyindolacetic acid | Bananas, plantains, kiwi, pineapple, nuts, and tomatoes |
Urine glucose is a direct interferent to the lipid peroxides assay. Patients with uncontrolled diabetes and elevated urine glucose may receive a result of 'not reportable, NR' for lipid peroxides. Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors lower blood sugar by disposing of excess glucose via urine.
The urine biomarkers are ratioed to urinary creatinine. The urine biomarkers include organic acids, urine amino acids and urine oxidative stress markers. If urinary creatinine is out of range, it can impact the levels of reported urine analytes which are used for nutrient recommendations. The collection instructions recommend not to drink more than six, 8-ounce glasses of liquid (48 ounces) 24 hours prior to sample collection because it can dilute the urine impacting the reported urine analytes. Below are considerations for altered urinary creatinine:
We do not recommend urine testing in a patient with known kidney dysfunction, defined by abnormal serum testing.
Testing is not available for children under 2 years old and samples will be discarded. Appropriate reference ranges have not been established for this population. We do not recommend squeezing liquid out of a diaper for sample collection, as this can result in altered concentrations of creatinine and biomarkers. A pediatric urine bag that can be taped to the body is available upon request for appropriate sample collection. While this is not a catheter procedure, instructions for catheterized patients can be followed below with regards to collecting and pooling all urine samples from the child's bedtime to early morning awakening.
It is unknown whether having a catheter placed will affect the results, or whether there will be any interference or decreased viability of the sample owing to this procedure. It is imperative to collect all urine samples from bedtime until early morning awakening. The bladder should be voided before bed. If the patient urinates during the night, the contents of the bag should be emptied into a clean container and refrigerated as soon as possible. This must be done each time urine is collected during the night. This may be inconvenient for the patient but would ensure a more viable sample. Finally, collect the first urine upon waking for the day, and combine that sample with all samples collected during the night. Ensure the combined sample is well mixed before transferring into the labeled tubes.
The reference ranges were not designed for a pregnant population. However, it may be useful to evaluate functional nutritional needs to optimize health during pregnancy, for both the mother and fetus. In pregnancy, the demand for various nutrients increases dramatically. The recommendations offered may reflect that increased nutritional burden. However, because the reference ranges were not established for this patient population, the implementation of nutrient recommendations or botanicals should be in accordance with standard pregnancy recommendations and precautions. Please refer to the link below addressing micronutrient needs during pregnancy and lactation:
The NutrEval® is both a blood and urine profile 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 your patient's test findings. Functional pillars with a built-in scoring system guide the need for therapeutic support in areas of methylation, toxic exposure, mitochondrial dysfunction, fatty acid imbalances, and oxidative stress. The NutrEval Plasma and NutrEval FMV (first morning void) differ based on which sample type is used to measure amino acids, plasma or urine.
We also offer the Metabolomix+, a similar profile that can be collected entirely at home – no blood draw required.
According to the World Health Organization, every country in the world is affected by one or more forms of malnutrition.[1] Nutritional imbalances are often root cause contributors to disease. Correcting these imbalances can result in optimized health and well-being of your patients.
*Testing is not performed in patients under 2 years old. However, NutrEval does include reference ranges and nutrient needs that apply to pediatric patients aged 2 and older.
The NutrEval report categorizes results into several metabolic areas (see sample reports in the Support Materials 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.[25,26]
| 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 |
Genova’s unique approach to nutritional testing begins by assessing the body’s biochemical pathways. Marked accumulation of organic acids or amino acids in urine can signal a metabolic inhibition or block. The metabolic block may be due to a nutrient deficiency, an inherited enzyme deficit, toxin build-up, or drug effect. Enzymes that are responsible for metabolizing organic acids and amino acids are vitamin and mineral dependent. With this, elevations in organic acids or amino acids can reflect a functional need for these nutrients on a cellular and biochemical level, even despite normal serum levels.[27,28,29,30,31] Recommendations for nutrient supplementation based on results are generated using a literature-based proprietary algorithm.
Traditionally, urinary organic and amino acid assessment has been used in neonatal/pediatric medicine to identify genetic inborn errors of metabolism, with severity depending on the degree and type of error.* In many cases of genetic inborn errors, the enzymatic defect may be compensated for by high doses of specific vitamin and mineral cofactors and/or dietary interventions. Intervention with higher-dose nutrient cofactors may also be effective in cases of decreased enzyme activity due to causes other than frank inborn errors.
There are various methods of assessing nutrient status, including intracellular and extracellular direct measurement, and measuring biochemical pathway markers. The NutrEval utilizes all of these methods, making it the only nutritional profile of its kind.
* Genova’s organic acid testing is not intended for the diagnosis of neonatal inborn errors of metabolism.
Nutrition is powerful! A few simple tweaks can make a big difference in your body and how you feel. Nutritional testing can help you identify your unique nutritional needs.
Nutrition is important for every body system. Poor nutrition contributes to many chronic diseases. If you struggle with any of the following conditions or are curious about your nutritional status, nutritional testing may be able to help identify the root cause of your ailments:
Genova’s nutritional testing provides a more complete assessment compared to what standard labs offer. Personalized recommendations for amino acids, fatty acids, vitamins, minerals, digestive support, and other nutrients are provided. Testing can also reveal toxic exposures and measure your body’s ability to neutralize those toxins.
The benefits of nutritional balance include healthy weight, mental wellness, disease prevention, and increased energy – if you are ready to feel your best, talk with your healthcare provider about nutritional testing.
The NutrEval requires both a blood draw and a urine sample. Review the Test Preparation tab to learn more about the collection process.
Certain medications, supplements, and/or foods may impact test results. Please note that the reference ranges were established based on patients who were taking no medications or supplements. In some instances it is unknown what potential impact a medication may have on test results.
Genova never recommends that patients discontinue medically necessary medications or supplements in order to complete testing.
There may be times when a patient may stay on a medication or dietary supplement during testing in order to evaluate its effectiveness. The recommendation to discontinue any substance is intended to establish a baseline finding. While there are no rigid rules on time frames for discontinuing supplements to establish a baseline, some clinicians choose to discontinue 4 days prior to testing. If you choose to discontinue a medication, a good rule of thumb is to take the biological half-life of the drug times 5 to allow for 'clearance' before testing. With certain medications, the drug itself may have cleared the body, but the effect of the medication may be longer lasting. Below you will find a list detailing the potential interference or influence of certain substances on the biomarkers.
| Dietary Factor | Possible Impact on Results |
| Artificial sweeteners and MSG | Artificial sweeteners and MSG are composed of amino acids which can directly impact measured amino acid levels |
| Eat your usual diet; avoid over-consuming any single food, extreme diets, or engaging in a rigourous activity (i.e. marathon) | Extreme diets and activity may impact certain organic acid biomarkers related to the citric acid cycle, neurotransmitter metabolites, dysbiosis markers, or amino acids |
| Phenol and flavonoid containing compounds in fruits, vegetables, chocolate, and tea can result in elevation of certain bacterial and fungal dysiosis markers on the organic acids profile | |
| Bananas, pineapple, kiwi, plums, avacado, walnuts, and pecans can result in an elevation of the serotonin metabolite 5-HIAA measured on the organic acids profile | |
| Seafood | Seafood containing heavy metals such as mercury and arsenic can result in a transient elevation |
| Six 8-ounce glasses of fluid | Creatinine concentration is influenced by fluid intake |
| Fasting, water allowed only | Reference ranges were set based on an overnight-fasted population. Overnight fasting minimizes influence of a single meal and provides a "steady diet" sample |
Medications and supplements may impact results. The discontinuation of any medication is at the discretion of the clinician, only if medically appropriate.
| Medications and Supplements | Possible Impact on Results |
| Valproic acid | Direct assay interferent for organic acid xanthurenic acid |
| Acetaminophen | Direct assay interferent for multiple organic acids |
| Berberine HCl | Direct assay interferent for organic acids IAA and 5-HIAA |
| Antibiotics, antifungals, probiotics, digestive enzymes, acid blocking medications | May indirectly influence urinary organic acid markers of malabsorption/dysbiosis Amino acid levels may be impacted by aminoglycoside antibiotics |
| Amphetamines, centrally acting medications, antidepressants, Anti-Parkinsonian medications | May influence urinary organic acid markers of neurotransmitter metabolism1,2 |
| HMG-CoA-reductase inhibitors (statins) and red yeast rice | May indirectly increase urinary organic acid B-methylglutaric acid levels |
| N-Acetyl Cysteine (NAC) | Direct assay interferent for cholesterol and triglycerides add-on tests; may lead to falsely low results |
| Oral contraceptives, estrogen therapy | May increase the organic acid quinolinic acid excretion both from altered tryptophan metabolism directly, as well as the indirect functional vitamin B6 insufficiency3 |
| Quercetin | May elevate the organic acid homovanillic acid4 |
| Steroids | May lower inflammatory neurotransmitter metabolite quinolinic acid, an organic acid |
| Diuretics | May impact creatinine concentration, thus affecting all urinary biomarker measurements |
| Fibrates | May influence fatty acid levels In some animal studies, fibrates also impact cellular energy metabolites on the organic acids profile |
| Kreb's cycle and amino chelated supplements (i.e. citrate, malate, succinate, glycinate, threonate, and orotate forms of supplements [magnesium citrate], alpha ketoglutarate, and others) | May result in elevations of corresponding Kreb's cycle markers and amino acids |
| Provocation/chelating agents (i.e. DMPS, DMSA, EDTA, etc.) | Reference ranges are based on a non-provoked, non-chelated patient population |
| Vitamin C | May increase urinary excretion of organic acid oxalic acid or lead |
Dietary Influences on urinary organic acids:4-16
| Urinary Metabolite | Common Dietary Sources |
| Indoleacetic acid | High tryptophan intake, green/black tea |
| Phenylacetic acid | Wine/grapes |
| Dihydroxyphenylpropionic acid | Whole-grains, chocolate, coffee, green/black tea, olives/olive oil, citrus fruits (animal studies) |
| 3-Hydroxyphenylacetic acid & 4-hydroxyphenlyacetic acid |
Wine/grapes, cranberries, green/black tea, berries, orange juice, grape seed extract |
| Benzoic acid/Hippuric acid | Orange juice, elderberry, huckleberry, food preservative, berries, other flavonoids |
| Citramalic acid | Apples, cranberries, sugar beets |
| Tartaric acid | Wine/grapes, chocolate, food additive/preservative |
| Malic acid | Fruits (apples, pears), vegetables, throat lozenges, syrups, beverages with food preservatives and additives |
| Homovanillic acid | Flavanols including tomatoes, onions and tea |
| 5-hydroxyindolacetic acid | Bananas, plantains, kiwi, pineapple, nuts, and tomatoes |
Urine glucose is a direct interferent to the lipid peroxides assay. Patients with uncontrolled diabetes and elevated urine glucose may receive a result of 'not reportable, NR' for lipid peroxides. Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors lower blood sugar by disposing of excess glucose via urine.
The urine biomarkers are ratioed to urinary creatinine. The urine biomarkers include organic acids, urine amino acids and urine oxidative stress markers. If urinary creatinine is out of range, it can impact the levels of reported urine analytes which are used for nutrient recommendations. The collection instructions recommend not to drink more than six, 8-ounce glasses of liquid (48 ounces) 24 hours prior to sample collection because it can dilute the urine impacting the reported urine analytes. Below are considerations for altered urinary creatinine:
We do not recommend urine testing in a patient with known kidney dysfunction, defined by abnormal serum testing.
Testing is not available for children under 2 years old and samples will be discarded. Appropriate reference ranges have not been established for this population. We do not recommend squeezing liquid out of a diaper for sample collection, as this can result in altered concentrations of creatinine and biomarkers. A pediatric urine bag that can be taped to the body is available upon request for appropriate sample collection. While this is not a catheter procedure, instructions for catheterized patients can be followed below with regards to collecting and pooling all urine samples from the child's bedtime to early morning awakening.
It is unknown whether having a catheter placed will affect the results, or whether there will be any interference or decreased viability of the sample owing to this procedure. It is imperative to collect all urine samples from bedtime until early morning awakening. The bladder should be voided before bed. If the patient urinates during the night, the contents of the bag should be emptied into a clean container and refrigerated as soon as possible. This must be done each time urine is collected during the night. This may be inconvenient for the patient but would ensure a more viable sample. Finally, collect the first urine upon waking for the day, and combine that sample with all samples collected during the night. Ensure the combined sample is well mixed before transferring into the labeled tubes.
The reference ranges were not designed for a pregnant population. However, it may be useful to evaluate functional nutritional needs to optimize health during pregnancy, for both the mother and fetus. In pregnancy, the demand for various nutrients increases dramatically. The recommendations offered may reflect that increased nutritional burden. However, because the reference ranges were not established for this patient population, the implementation of nutrient recommendations or botanicals should be in accordance with standard pregnancy recommendations and precautions. Please refer to the link below addressing micronutrient needs during pregnancy and lactation:
Your doctor will discuss your symptoms and help decide which test is right for you.
Many specimen collections can be completed from the privacy of your home.
Collection packs can be dropshipped directly to your home and everything you need to begin testing is included.
Already have a collection pack? Activate your test and begin today.
Use a calendar to plan for your collection.
Follow instructions carefully and be sure to add important details about you and your specimens in the Activation portal.
Ship your specimens using the prepaid FedEx materials provided.
Results are available online. Schedule time with your physician to review results and create a plan for your health.
Review information on the Test Preparation tab above for details on how medications and supplements may impact this test.
We provide a variety of testing services, and some of them may or may not be covered by your insurance plan.
Once your physician has ordered a Genova Diagnostics test for you, you can submit the CPT codes for your test to your commercial insurance plan to determine coverage. For information about billing options, please visit the Billing Information page.
Support guides, charts, and additional aids can be found on the Support Materials tab. Additional educational materials can be found in our Learning Library.
Genova also offers complimentary Medical Education Consultations for healthcare providers. Schedule consults online by signing in to your myGDX account.
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