Background: Vitamin E supplementation improves liver histology in patients with nonalcoholic steatohepatitis, which is a manifestation of the metabolic syndrome (MetS). We reported previously that a-tocopherol bioavailability in healthy adults is higher than in those with MetS, thereby suggesting that the latter group has increased requirements. Objective: We hypothesized that a-tocopherol catabolites a-carboxyethyl hydroxychromanol (a-CEHC) and a-carboxymethylbutyl hydroxychromanol (a-CMBHC) are useful biomarkers of a-tocopherol status. Design: Adults (healthy or with MetS; n = 10/group) completed a double-blind, crossover clinical trial with four 72-h interventions during which they co-ingested 15 mg hexadeuterium-labeled RRR-a-tocopherol (d 6 -a-T) with nonfat, reduced-fat, whole, or soy milk. During each intervention, we measured a-CEHC and a-CMBHC excretions in three 8-h urine collections (0-24 h) and plasma a-tocopherol, a-CEHC, and a-CMBHC concentrations at various times #72 h. Results: During the first 24 h, participants with MetS compared with healthy adults excreted 41% less a-CEHC (all values are leastsquares means 6 SEMs: 0.6 6 0.1 compared with 1.0 6 0.1 mmol/g creatinine, respectively; P = 0.002), 63% less hexadeuterium-labeled (d 6 )-a-CEHC (0.04 6 0.02 compared with 0.13 6 0.02 mmol/g creatinine, respectively; P = 0.002), and 58% less d 6 -a-CMBHC (0.017 6 0.004 compared with 0.041 6 0.004 mmol/g creatinine, respectively; P = 0.0009) and had 52% lower plasma d 6 -a-CEHC areas under the concentration curves [area under the curve from 0 to 24 h (AUC 0-24h ): 27.7 6 7.9 compared with 58.4 6 7.9 nmol/L 3 h, respectively; P = 0.01]. d 6 -a-CEHC peaked before d 6 -a-T in 77 of 80 paired plasma concentration curves. Urinary d 6 -a-CEHC 24-h concentrations were associated with the plasma AUC 0-24 h of d 6 -a-T (r = 0.53, P = 0.02) and d 6 -a-CEHC (r = 0.72, P = 0.0003), and with urinary d 6 -a-CMBHC (r = 0.88, P , 0.0001), and inversely with the plasma inflammation biomarkers C-reactive protein (r = 20.70, P = 0.0006), interleukin-10 (r = 20.59, P = 0.007), and interleukin-6 (r = 20.54, P = 0.01). Conclusion: Urinary a-CEHC and a-CMBHC are useful biomarkers to noninvasively assess a-tocopherol adequacy, especially in populations with MetS-associated hepatic dysfunction that likely impairs a-tocopherol trafficking. This trial was registered at clinicaltrials.gov as NCT01787591.Am J Clin Nutr 2017;105:571-9.