BACKGROUND/OBJECTIVES: The vitamin E derivative, alpha-tocopheryl acetate, is often included in formulations used in enteral nutrition. In this respect, we compared alpha-tocopherol and alpha-tocopheryl acetate absorption under 'maldigestion' conditions, such as occurring during enteral tube feeding, using differentially labeled RRR-[5,7-methyl-(21-16)]-alpha-tocopherol and RRR-[5-methyl-H-2(3)]-alpha-tocopheryl acetate allowing direct comparison between free and esterified forms. SUBJECTS/METHODS: The two derivatives were given together in a single dose to six volunteers directly into the jejunum using a double-balloon perfusion system. Perfusion lasted for 1 h, and the collected blood and effluent samples were analyzed by liquid chromatography-mass spectrometry. RESULTS: In the isolated 20-cm length of exposed jejunum, on average similar to 6% of the two vitamin E forms were absorbed >1 h based on subtraction of effluent from influent. There was substantial difference in the absolute absorbed quantity between individuals, but no significant differences were observed in the absorption between the two labeled forms as assessed in the plasma. H-2(3)-alpha-tocopherol was not present in the influent, but appeared in the effluent, indicating that the acetylated form of vitamin E is cleaved by brush border enzymes in the small intestine. CONCLUSIONS: This study shows that even in the absence of digestive enzymes and bile salts, the appropriately solubilized acetylated form of alpha-tocopherol exhibits the same bioavailability as free alpha-tocopherol. This suggests that both forms can be absorbed equally under maldigestion conditions such as present clinically during enteral tube feeding. European Journal of Clinical Nutrition (2013) 67, 202-206; doi:10.1038/ejcn.2012.183; published online 5 December 2012