How to Use the NutrEval FMV Test: Interpretation, Integration, and Outcomes

Nutritional deficiencies and metabolic imbalances are common globally, but they may go unrecognized when providers rely solely on routine blood panels. These gaps may contribute to the delayed identification of contributing factors in patients with persistent symptoms or health concerns.

The NutrEval FMV (First-Morning Void), developed as a laboratory test by Genova Diagnostics, measures a range of biochemical markers using urine and blood samples. 

It employs analytic methods such as GC-MS (Gas Chromatography-Mass Spectrometry) and LC-MS/MS (Liquid Chromatography–tandem Mass Spectrometry) to evaluate over 125 biomarkers related to nutritional and metabolic status, including vitamins, minerals, amino acids, fatty acids, oxidative stress, and detoxification.

Results are presented in organized categories. However, as with other laboratory-developed tests (LDTs), the findings aren’t FDA-cleared and should be interpreted within the context of a full clinical assessment.

This guide provides providers with a step-by-step overview of the full workflow, covering patient preparation, specimen handling, report interpretation, and the translation of data into actionable care strategies.

About the NutrEval FMV test

Before deciding when to use NutrEval, providers should know what it measures and how it differs from similar panels.

What the NutrEval FMV measures

The panel evaluates a wide range of nutritional and metabolic factors, making it a detailed functional assessment panel. It measures:

• 125+ biomarkers spanning vitamins, minerals, amino acids, organic acids, fatty acids, oxidative stress, and toxins.
• Sample sources include blood and first-morning urine, with an optional cheek swab for SNP (single-nucleotide polymorphism) analysis.
• Reports that provide visual scoring, functional domain summaries, general nutrient categories that may warrant clinical consideration, and biochemical pathway maps.
• Advanced technology, such as GC-MS and LC-MS/MS, for analytical precision under CLIA-certified conditions.

NutrEval FMV vs. Plasma vs. Metabolomix+

Several related panels are available, but they differ in scope and logistics:

• FMV: Uses urine-based amino acid analysis and includes oxidative stress markers and toxin panels.
• Plasma: Measures steady-state amino acids from blood and is less influenced by recent diet.
• Metabolomix+: Fully at-home collection with fewer biomarkers. It doesn’t include glutathione, CoQ10, vitamin D, or SNPs.

Choice depends on patient needs, compliance, and the level of detail required.

Clinical applications and ideal patient selection

The NutrEval FMV is most useful in cases where conventional testing leaves gaps.

Core use cases

Providers often order NutrEval for patients presenting with:

• Chronic fatigue, mood disturbances, or cognitive decline.
• Gastrointestinal dysfunction, food sensitivities, or malabsorption.
• Cardiometabolic risk factors or difficulties with weight regulation not explained by standard workups.
• Complex pediatric developmental concerns, reproductive health considerations, or questions related to athletic recovery.

Appropriate populations

The test is suitable for children over age two, adults with complex conditions, athletes seeking performance optimization, and patients with multiple supplement exposures. It’s particularly relevant in chronic illness or recovery states, where nutrient utilization may be impaired.

Preparing patients for testing

Patient preparation is essential for valid results. Providers should review protocols carefully with patients to minimize pre-analytical errors.

Pre-test preparation timeline

• Four days before testing, individuals are advised to stop taking non-essential supplements, fortified foods, MSG, and artificial sweeteners. 
• One day prior, they should continue their usual diet, limit fluids to about 1.5 liters, and avoid seafood. 
• The night before, an eight-hour fast should begin. 
• On the morning of the test, the first voided urine sample is collected, a cheek swab if needed, and a fasting blood draw is completed.

Special considerations

Testing should be avoided during menstruation or acute illness. Providers should also review medications that could interfere, such as diuretics, corticosteroids, or antifungals.

Cheek swab instructions (if ordered)

For patients completing genomic add-ons, ensure they:

• Don’t eat, drink, or brush teeth immediately before swabbing.
• Swab both cheeks for at least 30 seconds.
• Allow the swab to air-dry before sealing.

Specimen collection and logistics

Collection involves both urine and blood samples, with careful handling to maintain sample integrity.

Urine collection workflow

Patients collect the first-morning void, mix it, and transfer it into labeled tubes. Samples are shaken and frozen for at least two hours before shipping.

Blood collection protocol

Phlebotomy requires multiple tubes for serum and plasma separation. Key steps include centrifuging samples promptly, transferring to labeled tubes, freezing plasma/serum, and refrigerating others.

Packaging and shipping instructions

Providers should ensure the kit contains all necessary labeled samples, frozen components, activation card, and optional swab. Samples must be shipped overnight between Monday and Thursday to prevent delays.

Interpreting the report

Reports are structured into functional domains, biomarker categories, and supplemental recommendations.

Functional imbalance domains

Results are grouped into five primary pillars:

• Mitochondrial function
• Antioxidant need
• Detoxification status
• Fatty acid balance
• Methylation stress

This domain-based scoring helps providers prioritize interventions.

Biomarker categories and clinical implications

The report includes several biomarker panels:

• Organic acids: Reflect mitochondrial performance, microbiome metabolites, and detoxification intermediates.
• Amino acids: Provide insight into protein digestion, neurotransmitter precursors, and methylation.
• Fatty acids: Show omega 3/6/9 status and inflammation-related markers.
• Oxidative stress: Includes glutathione, CoQ10, and DNA/lipid damage markers.
• Elemental markers: Measure essential nutrients alongside heavy metals and environmental toxins.

Applying the results in practice

Results should be used to guide patient-centered care, rather than being seen as isolated data points.

• Providers can correlate NutrEval results with presenting symptoms, domain scores, and biochemical pathways.
• Reports may include algorithm-generated nutrient considerations, but these should be interpreted cautiously in the context of the patient's profile.
• Since NutrEval is typically cash-pay, transparency with patients about costs is essential. Practices may provide documentation for HSA/FSA reimbursement.

Frequently asked questions (FAQs)

When should I choose NutrEval FMV vs Plasma or Metabolomix+?

FMV is best for broad functional analysis, Plasma for stable amino acid profiles, and Metabolomix+ for at-home convenience with reduced scope.

What should patients stop eating or taking before the test?

Non-essential supplements, fortified foods, MSG, and artificial sweeteners should be avoided in the days leading up to testing.

How do I interpret yellow-zone (borderline) results?

These suggest a moderate imbalance. Providers should correlate with symptoms and consider targeted lifestyle or supplement adjustments.

What if the results are delayed beyond 14 days?

Delays may occur with shipping or processing. Providers should contact the lab if results are significantly late.

Can I integrate NutrEval with GI Effects or hormone panels?

Yes. Many providers combine NutrEval with GI or hormone testing for a more complete functional assessment.

What are common lab errors or pitfalls during collection?

Mistakes include unlabeled tubes, insufficient urine volume, or delayed shipping. Clear patient instructions help prevent these.

Key takeaways

• The NutrEval FMV test provides providers with a broad overview of nutrient status, metabolic function, and oxidative balance, offering insights that aren’t always available through routine lab testing.
• Proper patient preparation, including fasting and supplement adjustments, plays an important role in reducing variability and ensuring reliable results.
• The report organizes findings into functional domains such as mitochondrial efficiency, antioxidant need, detoxification capacity, fatty acid status, and methylation activity, which can help providers prioritize areas of support.
• Interpreting NutrEval requires careful integration with the patient’s medical history, symptoms, diet, and other test results, since no single panel is sufficient to make a diagnosis on its own.
• The test is generally offered on a cash-pay basis, but providers can support patients by providing documentation for potential HSA/FSA reimbursement and by clearly communicating expected costs and benefits.
• NutrEval results can complement other panels such as stool analysis, hormone testing, or toxin exposure assessments, helping providers build a more comprehensive care strategy and track changes over time with follow-up testing.

Disclaimer:

This article is for educational purposes only. NutrEval FMV and related panels are laboratory-developed tests that should be ordered and interpreted by qualified healthcare professionals. Test results should not be used as standalone diagnostic tools. Always integrate findings with clinical history, examination, and standard medical evaluations.