Abstract
Barely one quarter of the world's population consumes some four-fifths of the available alcohol. With the inexorable rise in world production it is not surprising that some communities are facing an explosive increase in alcohol-related problems. Yet, as Kreitman has pointed out [1], a great number of alcohol problems derive not from the hard core of very excessive and addicted consumers, with their very high risks, but from among the large 'middle-ground' of so-called moderate consumers, This fact serves to highlight the paradox for the hepatologist which, despite colossal endeavour, is still unanswered - namely: why do only a proportion of drinkers suffer from alcoholic liver disease (ALD)_ Although overall the level of consumption of alcohol in communities is determinative and risks rise with increasing daily consumption [2], factors other than alcohol itself are also clearly involved [3]. These factors doubtless include endogenous determinants (predisposition) and exogenous determinants (such as other hepatotoxins and possibly viral infections) [4].
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