NutrEval Testing: 101

Nutritional insufficiencies commonly cause and result from disease processes. The Standard American (SAD) diet does not promote optimal nutrition or health. 31% of the American population is at risk for at least one vitamin deficiency, and 60% have at least one chronic disease. The origins of chronic disease are multifactorial, but nutrition certainly has a role.

Nutritional testing is a beneficial tool for doctors deciphering complex patient histories. This specialty test can give insight into the root cause of preexisting diseases and symptoms. It can also guide dietary and supplemental treatment recommendations and provide information regarding disease risk.

Combining various testing methods, Genova Diagnostics offers a comprehensive nutritional analysis called NutrEval. This article will discuss the NutrEval Plasma and NutrEval FMV: what they are and how functional doctors use them.

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What is the NutrEval Test?

The NutrEval is Genova Diagnostic's most comprehensive nutritional assessment of organic acids, oxidative stress, amino acids, fatty acids, micronutrients, and toxic elements. It evaluates over 125 biomarkers in blood and urine samples related to the body's function on a biochemical and metabolic level, aiding in diagnosing nutritional deficiencies and insufficiencies.

Highlight features of the NutrEval report include:

• A scoring system in functional areas of imbalance (oxidative stress, mitochondrial dysfunction, fatty acid imbalance, methylation imbalance, and toxic exposure) that guides therapy prioritization and recommendations
• The Nutrient Need Overview spotlights nutrient insufficiencies and personalized recommendations for vitamins, minerals, amino acids, fatty acids, and digestive support based on the patient's test findings, demographics, and scientifically-developed nutrient intake recommendations
• The Interpretation-At-A-Glance is an educational aid on nutritional importance, reasons for and complications of deficiencies, and how to meet nutritional goals through dietary modifications.
• Graphics throughout the report act as visual aids that integrate the patient's results into the key biochemical pathways, making results easier to interpret and understand.

What Does the NutrEval Plasma Test Measure?

NutrEval measures blood and urinary biomarkers specific to several fundamental metabolic areas described below.

Organic Acids

Organic acids are urinary metabolic byproducts that provide insight into intestinal malabsorption and dysbiosis, mitochondrial energy production, nutritional status, toxin load, and detoxification. The organic acid report categorizes results into six major metabolic areas:

• Protein malabsorption and bacterial/yeast dysbiosis
• Cellular energy and mitochondrial energy: related to the biochemical reactions that derive energy from carbohydrates, fats, and proteins
• Vitamin markers: a collection of functional analytes that relate to specific needs for vitamins, particularly the B vitamins
• Neurotransmitter metabolites: breakdown products of epinephrine, norepinephrine, serotonin, and dopamine that help to assess vitamin cofactor status
• Toxin and detoxification markers: insight into the body's antioxidant status and detoxification capacity
• Oxalate Markers: products of oxalate metabolism, which are strongly associated with kidney stone risk, oxidative stress, and metabolic dysfunction.

Oxidative Stress

Oxidative stress occurs when the production of unstable, inflammatory molecules is greater than the body's ability to remove and stabilize them. Increased oxidative stress increases cellular damage and is implicated in various chronic diseases, like cancer, atherosclerosis, and autoimmune disease. This portion of the test can help quantify the need for antioxidant support based on cellular/DNA damage and antioxidant levels.

Amino Acids

Amino acids are the building blocks for proteins. They play numerous roles in the body, including energy generation, neurotransmitter and hormone synthesis, growth and repair, immune function, and blood cell production. The amino acid analysis includes essential and nonessential amino acids, giving insight into the patient's dietary protein intake and endogenous production of amino acids. Intermediary metabolites (byproducts of amino acid metabolism) may indicate the need for B vitamin cofactors or suggest genetic variations impeding optimal function. The additional dietary peptide-related markers measured in this section provide information regarding dietary meat intake, incomplete protein digestion, and muscle breakdown.

Fatty Acids

Fatty acids are measured in the red blood cell as a weighted percentage of the cell membrane. This measurement reflects fatty acid status over the last 90-120 days. The NutrEval provides a detailed analysis of fatty acid status, measuring many analytes within the following categories:

• Omega-3 fats
• Omega-6 fats
• Omega-9 fats
• Saturated fats
• Monounsaturated fats

The Omega-3 Index, an evidence-based calculated measurement of EPA and DHA in red blood cell membranes, can be used to quantify cardiovascular risk.

Nutrient and Toxic Elements

Copper, zinc, magnesium, potassium, manganese, and selenium levels are directly measured from plasma, red blood cells, and whole blood.

Toxic element markers indicate recent lead, mercury, arsenic, or cadmium exposure within the last 90-120 days.

Optional Add-Ons

Doctors can add a serum vitamin D measurement and/or genetic testing of four common genetic variants (MTHFR, COMT, TNF-alpha, and APOE) through a buccal swab collection onto this test.

What's the Difference Between the NutrEval FMV & NutrEval Plasma?

Different amino acid analytes are measurable in blood versus urine. While NutrEval FMV measures amino acids in urine, the plasma version of the test measures them through the provided blood sample. The NutrEval FMV will measure 40 amino acid analytes, whereas the NutrEval Plasma can only measure 36. The tests are otherwise identical. Both tests require both a fasting blood draw and first-morning urine collection.

What is the Difference Between Plasma and Urine Amino Acids?

Deciding between these two tests will depend on the doctor's clinical concern and the patient's dietary habits. Plasma amino acids reflect an average protein intake over three weeks and are unaffected by short-term nutritional fluctuations. NutrEval Plasma is recommended for patients with inconsistent daily protein intake, those with mood disorders, and those with kidney disease causing proteinuria (excess amounts of protein in urine).

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Urinary amino acids are more reflective of recent dietary protein intake over the last 48-72 hours and will be affected by short-term dietary changes. For patients with a consistent and controlled daily protein intake, ordering NutrEval FMV is appropriate.

When to Consider the NutrEval Test

The analytes measured on the NutrEval test provide valuable insight into your patients' micro- and macronutrient status. Nutritional insufficiencies are often contributors to disease. This test applies to many medical conditions, including, but not limited to:

• Mood disorders
• Cardiovascular disease
• Metabolic diseases, like obesity, insulin resistance, and type 2 diabetes
• Chronic fatigue
• Gastrointestinal disorders
• Disordered eating and malnutrition

Additionally, this test can be a helpful tool for those seeking dietary guidance to optimize aging or athletic performance and prevent disease.

How to Use the NutrEval Test in Clinic

The NutrEval is an indicated functional nutritional analysis that can be ordered for any patient over two years old. This test's results will help doctors make dietary, lifestyle, and supplemental recommendations to optimize nutritional status and metabolic health and prevent disease.

It is important to review patient collection instructions to accurately guide patients through the collection process to ensure adequate samples and accurate test results. Key patient preparation points include:

• Patients must collect a first-morning urine sample and have a fasting blood draw on collection day. The urine sample and cheek swab (if ordered for genetic SNPs add-ons) should be collected immediately upon waking before putting anything in the mouth.
• Patients should fast overnight (water is okay) before collecting samples
• Patients should eat their typical diet the day before sample collections and should not consume over 48 ounces of liquid 24 hours before the collection to prevent dilution of urinary analytes.

Determining whether a patient should discontinue supplements prior to collecting test samples depends on the reason for ordering the test. Doctors may advise patients to stop supplements if the goal is to measure a baseline nutritional status. Otherwise, patients can continue taking supplements leading up to the test if the test functions to monitor a patient's response to supplemental therapies.

Some results from this test may indicate the need for additional testing to understand highlighted imbalances better. Other Genova test options that someone could consider ordering in addition to the NutrEval include:

• Methylation Panel to better understand methylation pathways affecting metabolism
• GI Effects Comprehensive Profile as an in-depth stool analysis to evaluate digestive health and function
• Cardio Check to stratify cardiovascular disease risk better
• Toxic Element Clearance Profile to further investigate toxic load

If planning to repeat the NutrEval test to monitor treatment, waiting at least 3-4 months for the most accurate results is recommended.

Summary

Nutritional status contributes to physical symptoms of dis-ease and can be measured on a cellular level through specialty testing. Genova Diagnostic's comprehensive NutrEval panels (plasma and FMV) combine organic acid and micronutrient testing to analyze a patient's nutritional needs thoroughly. This test can be applied to a multitude of health concerns. NutrEval's user-friendly report offers simplified scoring systems, graphics, and personalized recommendations, allowing straightforward interpretation of test results. NutrEval is an excellent tool for those wanting to treat and prevent disease.