There is no doubt that excessive alcohol consumption leads to liver disease—from simple fatty liver to cirrhosis—in certain individuals. Questions which remain unanswered concern the relation between dose and disease risk, including the existence of a “dose threshold”, the influence of sex and the precise proportion of heavy drinkers who will develop significant liver disease. Most of the relevant data have, until very recently, come from retrospective studies assessing alcohol intake in hospitalised patients at the time of diagnosis. Clearly, these studies on highly selected patients are subject to many confounding influences,1 and are also unable to provide any information on the risk of liver disease in the population stratified into drinking categories. Of the two main prospective studies that have been performed, one was confined to men and showed no dose-response relation2 and the other demonstrated no threshold effect or sex difference in disease susceptibility.3 These controversial issues have now been readdressed by two recent studies that have used different but complimentary methodological approaches, one from Becker and colleagues4 and another from Bellentani and the Dionysos Study Group reported in this issue (see page 845).

Becker et al carried out a longitudinal study of the association between self-reported alcohol intake and the risk of future liver disease in a large population based prospective cohort of 13 285 subjects …