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Methylmalonic Acid (MMA) Test
Reviewed by Medicinsk Expert•Last updated: 2026-10-22•Lab Tests

Methylmalonic Acid (MMA) Test

The MMA test measures the level of methylmalonic acid in your blood or urine to help diagnose vitamin B12 deficiency and certain rare genetic disorders.

What is a methylmalonic acid (MMA) test?

This test measures the amount of methylmalonic acid (MMA) in your blood or urine. MMA is a substance produced during the digestion of protein. Vitamin B12 is required to break down MMA; therefore, high levels of MMA can indicate a vitamin B12 deficiency. Vitamin B12 is essential for metabolism and the production of red blood cells.

Why do I need an MMA test?

You may need this test if you exhibit symptoms of a vitamin B12 deficiency, which include:

  • Fatigue and dizziness
  • Shortness of breath
  • Tingling in hands and/or feet
  • Mood changes, confusion, or irritability
  • Loss of appetite
  • Pale skin

You may be at higher risk for deficiency if you are a strict vegetarian or vegan, have digestive diseases like celiac or Crohn's disease, have an alcohol use disorder, or are older than 75 years.

What happens during an MMA test?

MMA levels can be checked via a blood sample or a urine sample. For a blood test, a professional collects a small amount of blood from a vein in your arm. For urine testing, you may be asked to provide a random sample or a 24-hour collection, where you store all urine produced over a 24-hour period in a special container.

What do the results mean?

Higher-than-normal levels of MMA may indicate a vitamin B12 deficiency. Your provider will likely compare these results with other tests, such as a homocysteine blood test, to confirm a diagnosis. In newborns, high levels of MMA may indicate methylmalonic acidemia, a rare genetic disorder that requires prompt medical attention.

Frequently Asked Questions

Most labs do not require fasting for MMA. However, avoid taking B12 supplements or high‑dose multivitamins for at least 24 hours before the test, as they can lower MMA levels. Inform your clinician of all medications, especially metformin or proton pump inhibitors, which may affect results.
MMA is a more sensitive marker for functional B12 deficiency. Normal serum B12 can mask a deficiency if the B12 is bound to proteins or if absorption is impaired. Elevated MMA indicates that B12 is not effectively used in the body, prompting further evaluation.
The clinician will typically order a serum B12 test, a holotranscobalamin (active B12) assay, and a homocysteine level. If these confirm deficiency, they will prescribe B12 supplementation and monitor both B12 and MMA levels over time to ensure response.===
You will collect all urine produced over a 24‑hour period in a special container, usually starting at 7 a.m. and ending at the next 7 a.m. This method reduces day‑to‑day variation and is especially useful when blood sampling is difficult or when a more precise assessment of MMA excretion is needed.
Source: MedlinePlus, National Library of Medicine

MedlinePlus brings together authoritative health information from the National Library of Medicine (NLM), the National Institutes of Health (NIH), and other government agencies and health-related organizations.

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