Recent advances in the understanding of the physiology of berry growth and in modelling allow simulation of fruit growth and sugar accumulation from the perspective of water and carbon balance. This review summarises present knowledge on the modelling and molecular physiology of carbon and water fluxes related to grape berry growth and quality. It focuses principally on the effects of environmental factors and cultural practices on fruit quality through their consequences on water and carbon fluxes during fruit growth. Together with ecophysiological and molecular approaches, process-based models show promising ability to aid in integrating physiological results, generating novel hypotheses and consequently providing a full picture of the control of berry growth and quality development. In the future, nitrogen and sulfur fluxes, necessary for the synthesis of secondary metabolites important for quality, should also be integrated. Modelling at the organ level should extend to metabolic content and metabolite fluxes (metabolomic and fluxomic studies). Genotypes naturally or artificially affected on a key gene or function will also be helpful to validate modelling hypotheses.