Nutrition Profiles Test Prep
NutrEval® FMV and Metabolomix+
Thank you for choosing Genova Diagnostics for your nutritional evaluation. We provide written instructions, videos and additional online resources to help prepare and collect for the test. Below you can watch video intructions for specimen collection, as well as access patient and clinician preparation to consider prior to collection.
Step-by-Step Collection Instructions
These videos walk through preparing for and collecting urine samples and saliva samples. Additional specimen collection instructions are provided below for your convenience.
- NutrEval FMV
Important Prep Before Taking the Test
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.
Please consult with your healthcare provider before stopping any prescription or over-the-counter medications or dietary supplements. Genova never recommends that patients discontinue medically necessary medications or supplements in order to complete testing.
There may be times when your healthcare provider prefers that you stay on a medication or dietary supplement during testing in order to evaluate its effectiveness.
Use a calendar to plan for sample collection
Do not collect samples while experiencing active bleeding from menstruation or any condition resulting in blood in the urine (hematuria).
Be sure to schedule phlebotomy and plan the at-home collection around the date of your appointment. Complete the urine collection the day before your phlebotomy appointment.
Plan to ship your specimens within 24 hours of the blood draw. Only ship Monday thru Friday and take note of any holidays that may impact your shipment.
4 days before urine collection
Discuss the discontinuation of nonessential supplements and medications that may impact results with your physician.
Some clinicians choose to discontinue nonessential nutritional supplements to get a "baseline" reading while others choose to continue nutritional supplementation to assess the efficacy of treatments.
24 hours before urine collection
- Eat your usual diet. Avoid over-consuming any single food or extreme diets.
- Freeze the provided freezer brick.
- Limit fluid intake to six 8-ounce glasses of fluid.
Night before urine collection
- Fast overnight and leading up to urine collection. Water is okay.
Day of urine collection 24 hours before blood draw
- Collect your urine if you wake during the night, within 6 hours of your morning urination - refrigerate. Upon waking in the morning, collect your urine into the same container.
- Transfer urine from your collection container into the provided tubes, following the kit instructions.
- Place tubes in freezer with the provided freezer brick. Tubes must be frozen for a minimum of 2 hours.
- Fast overnight and leading up to your phlebotomy appointment tomorrow. Water is okay.
If you are completing the Cheek Swab:
- Do not use mouthwash during your nightly dental hygeine routine. Brushing and flossing is okay.
Morning of blood draw and/or cheek swab collection
- Complete the cheek swab immediately upon rising. Do not practice your normal oral hygiene routine and do not eat or drink anything other than water before performing the cheek swab.
- Continue to fast before your phlebotomy appointment. Water is okay.
- Pack and bring your frozen specimens and cheek swab collection with you to your phlebotomy appointment.
Immediately after blood draw
- Follow the collection instructions and ship your completed collection pack Monday thru Friday only.
Scroll to Top for Patient Instructions
Please follow instructions carefully.
- If any items are missing or expired, call Client Services at +44 (0)20 8336 7750
- Keep the kit box for shipping the specimen to the lab
Important Prep Before Taking the Test
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.
Please consult with your healthcare provider before stopping any prescription or over-the-counter medications or dietary supplements. Genova never recommends that patients discontinue medically necessary medications or supplements in order to complete testing.
There may be times when your healthcare provider prefers that you stay on a medication or dietary supplement during testing in order to evaluate its effectiveness.
Use a calendar to plan for sample collection
Do not collect samples while experiencing active bleeding from menstruation or any condition resulting in blood in the urine (hematuria).
Plan to complete the urine collection, bloodspot collection (if ordered), and cheek swab (if ordered) on the same morning.
Plan to ship your specimens 24 hours after the final collection. Only ship Monday thru Friday and take note of any U.S. holidays that may impact your shipment.
4 days before specimen collection
Discuss the discontinuation of nonessential supplements and medications that may impact results with your physician.
Some clinicians choose to discontinue nonessential nutritional supplements to get a "baseline" reading while others choose to continue nutritional supplementation to assess the efficacy of treatments.
24 hours before specimen collection
- Eat your usual diet. Avoid over-consuming any single food or extreme diets.
- Freeze the provided freezer brick.
- Limit fluid intake to six 8-ounce glasses of fluid.
Night before specimen collection
- Fast overnight and leading up to specimen collection. Water is okay.
- If collecting a cheek swab, do not use mouthwash during your nightly dental hygeine routine. Brushing and flossing is okay.
Day of specimen collection
- Collect your urine if you wake during the night, within 6 hours of your morning urination and refrigerate. Upon waking in the morning, collect your urine into the same container.
- Stir then transfer urine from your collection container into the provided tubes, following the kit instructions.
- Place tubes in freezer with the provided freezer brick. Tubes must be frozen for a minimum of 2 hours.
- Complete the cheek swab immediately upon rising (if ordered). Do not practice your normal oral hygiene routine and do not eat or drink anything other than water before performing the cheek swab.
- Complete the bloodspot collection (if ordered). Do not eat or drink anything other than water before performing the collection.
24 hours after collection
Pack your the frozen freezer brick, frozen urine specimens, cheek swab collection, and fully dried bloodspot collection card into their original packaging and follow the instructions to ship your completed collection pack Monday thru Friday only.
Scroll to Top for Patient Instructions
Please follow instructions carefully.
- If any items are missing or expired, call Client Services at +44 (0)20 8336 7750
- Keep the kit box for shipping the specimen to the lab
Step-by-Step Collection Instructions
This video walks through preparing for and collecting blood samples for the NutrEval Profiles
Additional specimen collection instructions are provided below for your convenience.
Important Prep Before Patient Takes Test
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 |
Diabetic Patients
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.
Urinary Creatinine Levels and Kidney Function
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:
- Elevated Creatinine: High muscle mass, heavy exercise or increased physical activity, increased protein intake, significant dehydration, and increased renal clearance.
- Low Creatinine: Poor renal clearance or dysfunction, low muscle mass (i.e. physical inactivity or muscle wasting disease), diluted urine (use of diuretics), malnutrition/protein insufficiency, and hypothyroidism.
We do not recommend urine testing in a patient with known kidney dysfunction, defined by abnormal serum testing.
Pediatric Patients
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.
Urinary Catheters
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.
Pregnant Patients
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:
References
- Grouzmann E, Lamine F. Determination of catecholamines in plasma and urine. Best Pract Res Clin Endocrinol Meta. 2013;27(5):713-723.
- Alam N, Wasi N, Naeem S, et al. Methylphenidate increases the urinary excretion of vanillylmandelic acid in rats that is attenuated by buspirone co-administration. Pak J Pharm Sci. 2019;32(2 (Supplementary)):895-898.
- Rose D, Toseland P. Urinary excretion of quinolinic acid and other tryptophan metabolites after deoxypyridoxine or oral contraceptive administration. Metabolism. 1973;22(2):165-171.
- Combet E, Lean ME, Boyle JG, Crozier A, Davidson DF. Dietary flavonols contribute to false-positive elevation of homovanillic acid, a marker of catecholamine-secreting tumors. Int J Clin Chem. 2011;412(1-2):165-169.
- Zamora-Ros R, Achaintre D, Rothwell JA, et al. Urinary excretions of 34 dietary polyphenols and their associations with lifestyle factors in the EPIC cohort study. Sci Rep. 2016;6:26905.
- Ward NC, Croft KD, Puddey IB, Hodgson JM. Supplementation with grape seed polyphenols results in increased urinary excretion of 3-hydroxyphenylpropionic Acid, an important metabolite of proanthocyanidins in humans. J Agric Food Chem. 2004;52(17):5545-5549.
- Sugimoto N, Forsline P, Beaudry R. Volatile Profiles of Members of the USDA Geneva Malus Core Collection: Utility in Evaluation of a Hypothesized Biosynthetic Pathway for Esters Derived from 2-Methylbutanoate and 2-Methylbutan-1-ol. J Agricul Food Chem. 2015;63(7):2106-2116.
- Hulme A. The isolation of L-citramalic acid from the peel of the apple fruit. Biochim Biophys Acta. 1954;14:36-43.
- Liu H, Garrett TJ, Su Z, Khoo C, Gu L. UHPLC-Q-Orbitrap-HRMS-based global metabolomics reveal metabolome modifications in plasma of young women after cranberry juice consumption. The J Nutr Biochem. 2017;45:67-76.
- Khorassani R, Hettwer U, Ratzinger A, Steingrobe B, Karlovsky P, Claassen N. Citramalic acid and salicylic acid in sugar beet root exudates solubilize soil phosphorus. BMC plant biology. 2011;11(1):121.
- van der Hooft JJ, de Vos RC, Mihaleva V, et al. Structural elucidation and quantification of phenolic conjugates present in human urine after tea intake. Analyt Chem. 2012;84(16):7263-7271.
- Jacobs DM, Fuhrmann JC, van Dorsten FA, et al. Impact of short-term intake of red wine and grape polyphenol extract on the human metabolome. J Agricul Food Chem. 2012;60(12):3078-3085.
- Rios LY, Gonthier M-P, Rémésy C, et al. Chocolate intake increases urinary excretion of polyphenol-derived phenolic acids in healthy human subjects. Am J Clin Nutr. 2003;77(4):912-918.
- Henning SM, Wang P, Abgaryan N, et al. Phenolic acid concentrations in plasma and urine from men consuming green or black tea and potential chemopreventive properties for colon cancer. Mol Nutr Food Res. 2013;57(3):483-493.
- Feliciano RP, Boeres A, Massacessi L, et al. Identification and quantification of novel cranberry-derived plasma and urinary (poly)phenols. Arch Biochem Biophys. 2016;599:31-41.
- Corcuff J-B, Chardon L, El Hajji Ridah I, Brossaud J. Urinary sampling for 5HIAA and metanephrines determination: revisiting the recommendations. Endocr Connect. 2017;6(6):R87-R98.
