The incidence of steatorrhea is said to be lower and its grade milder in Japanese because their fat intake is lower than that of Europeans and Americans. Failure to take this into account creates difficulties when attempting to compare data on pancreatic exocrine insufficiency in different countries. The authors examined the incidence and grade of steatorrhea in Japanese chronic pancreatitis (CP) patients whose daily fat intake was <40 g (25 patients) or > or =40 g (35 patients). In addition, 23 CP patients with steatorrhea and daily fecal fat excretion > or =5 g were given a pancreatic enzyme preparation at a dose 3-8 times higher than the usual dose to investigate its effect on fecal fat excretion. Among CP patients whose fat intake was <40 g, the incidence of fecal fat excretion <5 g was 56% and that of fecal fat excretion > or =10 g (severe steatorrhea) was 8%. In CP patients whose fat intake was > or =40 g, the incidences were 27.9 and 34.9%, respectively; a significant increase in the number of affected patients was noted when fat intake was > or =40 g. The fat absorption rate was 76.2% among patients whose fat intake was <40 g and 77.8% among patients whose fat intake was > or =40 g, revealing no significant difference between the two groups. The proportion of CP patients whose fat absorption rate < or =80% was 32% at a fat intake <40 g and 39% at a fat intake > or =40 g, revealing no significant difference between the two groups.