Bibliometric analysis of nutrition and dietetics research activity in Arab countries using ISI Web of Science database

According to the World Health Organization, micronutrient deficiencies and underweight problems are common in the Eastern Mediterranean Region (EMR); (WHO/EMRO 2012). On the other hand, overweight and obesity have reached alarming limits in most of the countries in EMR (Musaiger 2011). Furthermore, prevalent health conditions in Arab countries such as diabetes mellitus, osteoporosis, and cardiovascular diseases have been linked to nutritional habits in the EMR (Musaiger 2011). Reducing nutrition-related health problems in Arab countries requires an understanding of the performance of Arab countries in the field of nutrition and dietetics research. Assessment of research activity from a particular country or region could be achieved through bibliometric analysis (Bramness et al. 2014; Zyoud et al. 2014c). Bibliometrics Analysis of research output from a particular country is an image of its research activity and its current economic, developmental and health status (De Battisti and Salini 2013). No bibliometric studies have carried out to assess research activity in the field of nutrition and dietetics from any Arab country or Arab region. Internationally, few studies in this regard were published. For example, a bibliometric analysis of nutrition literature of Bangladesh showed that a total of 636 articles were published in 100 local and foreign journals with a rapid growth of nutrition literature from 1987 onwards (Ahmed and Rahman 2008). Another study from China showed that the number of Chinese literature on clinical nutrition had increased steadily from 1 paper in 1974 to 1980 papers in 2011 and that clinical nutrition has become one of the hot research topics in China in recent years, although the appropriate and reasonable use of clinical nutrition remain challenging (Yu et al. 2013) Of course, research activity and capacity of a particular country depends on several factors including the national income and the size of population. In the case of Arab countries with approximately 400 million population and huge resources, excellence in research is a must. According to Arab League, there are 22 Arab countries and territories with varying degrees of income, population size, food industry and agricultural capacities. Arab countries, with approximately 400 million people, share similar language, culture, religion and historical background. Living standards, medical education, health services, political reform and awareness have become evident in most Arab countries. This should have been accompanied by increase in scientific research output. Therefore, the objective of this study was to analyze the research activity in nutrition and dietetics in Arab countries using bibliometric approach. The results of the study will provide baseline data on the quantity and quality of research in nutrition and dietetics category and will help direct research in this field in the future.

Data used in this study were extracted from ISI Web of Science (WoS) in which various scientific disciplines are being grouped into various categories based on the field of interest of journals indexed in ISI WoS. For the purpose of this study, the category chosen for analysis was “nutrition and dietetics”. Web of Science is easy to use and has a simple and advanced search tools. Results of advanced search analysis can be copied and transferred to Microsoft excel for analysis at any point during analysis. Detailed citation analysis of the results of the advanced search can also be easily obtained.

In this study, WoS was used rather than PubMed database. A comprehensive analysis of the advantages and disadvantages of various databases including WoS, PubMed, and Scopus was presented by Falagas et al (2008). In contrast to PubMed, WoS covers most scientific publication and not only the medical and biomedical publication as in the case of PubMed. Furthermore, WoS covers the oldest publications and its records go back to 1900. A major disadvantage of PubMed is the fact that it does not provide citation analysis and therefore does not allow for qualitative analysis of published literature (Falagas et al. 2008). Furthermore, although nutrition is a medical subject, research about nutrition could have been carried out and published in non-medical journals which make PubMed less suitable for this purpose than WoS. In this study, we used ISI WoS rather than Scopus for two main reasons. First of all, no category research is available through Scopus. In contrast, the ISI WoS has a special function in the advanced search that allows investigator to screen for all published articles under the category “nutrition and dietetics”. This is a major advantage of ISI WoS versus Scopus when doing bibliometric analysis of published articles in a special category or field. Second, it is important to note that ISI WoS includes highly citable and influential journals. Such published articles are the ones that affect the practice of nutritional science in the world.

In this study, 21 Arab countries were entered into advanced search engine in WoS followed by “nutrition and dietetics” as WoS category. Palestine was excluded from search keys because the WoS database does list Palestine as an independent state. The results were refined and limited to original research articles and review articles. The time frame for the result was up to year 2012.

Nutrition research is important for human development as well as for improving national health status. No doubt that research regarding nutrition and dietetics is highly needed in Arab countries in order to have baseline data to be used for implementation of nutrition programs directed to solve nutrition-related issues. In our study, a total of 2062 original research articles and reviews related to nutrition and dietetics were retrieved from Arab countries. The actual number of documents might be higher than this given that some journals in which Arab researchers have published about nutrition were not indexed in WoS. For example, Eastern Mediterranean Health Journal is one of the regional journals in the field of public health in which many Arab researchers had published in the field of nutrition; however, documents published in this journal were not counted because it is not indexed in ISI Web of Science. Despite this limitation, our study does give a clear picture and a very close approximation of the quantity, quality, citation analysis, and international collaboration activity of documents in the field of nutrition and dietetics published from Arab countries.

Our results indicated that Kuwait ranked first in research productivity regarding nutrition research measured per million inhabitants. Nutrition-related problems in Kuwait and other gulf countries are due to nutritional transition and overconsumption of food (Musaiger 2011; Hubail and Culligan 2012). A study in seven Arab countries found that, Kuwaiti adolescents had the highest prevalence of obesity (Musaiger et al. 2012b). The findings that Bahrain ranked third in number of documents per million was also expected since the prevalence rates for obesity and diabetes mellitus in Bahrain are higher than the global average (Hubail and Culligan 2012). Obesity and diabetes mellitus have reached alarming limits in Arab Gulf countries and no wonder that researchers from these countries had high research activity regarding nutrition. Furthermore, the relatively good economy of Arab gulf countries participated in pushing medical research activity forward.

Our results showed that interest of Arab researchers in nutrition research showed a dramatic increase only in the last decade. This might be due to alarming epidemiological studies published in late 1990s regarding diabetes mellitus, hypertension and chronic kidney diseases which might be linked to nutrition (El Mugamer et al. 1995; Ibrahim et al. 1995; Musaiger and Al-Roomi 1997; Shaheen and Al-Khader 2005). Arab countries have surpassed Israel, Turkey and Iran in nutrition research activity. However, the quality, as measured by citation analysis, of research from Arab countries was not higher than that produced by Israel or Turkey. This means that although attention to nutrition research is growing, the type and quality of publications is not as those from Israel or Turkey.

Research areas of published documents in the field of nutrition and dietetics from Arab countries were mainly in “Food Science/Technology and Chemistry”. Similar top research areas were found with worldwide published documents in the field of nutrition and dietetics. However, these two research areas constituted approximately 75% of the research area of published nutrition documents from Arab countries compared with approximately 27% for these two research areas for worldwide published nutrition documents. This difference is mainly due to lack of information on chemical composition of local foods and herbs commonly consumed and used in Arab countries. Furthermore, no doubt that processed food technology is new to Arab countries and therefore research in this area is appealing to many of those who are in the field of nutrition, public health, toxicology and industry.

Our study showed that the number of nutrition documents related to diabetes mellitus, or cancer or obesity published from Arab countries was 16% compared with 21% for worldwide nutrition-related diabetes mellitus, pr cancer or obesity. Despite the fact that prevalence rates of diabetes mellitus and obesity have reached alarming limits in some Arab countries, nutrition- related research in these health topics was lagging behind in Arab countries. Recent studies indicated that non-communicable diseases have largely replaced infectious diseases in most Arab countries as a leading cause of death (Mokdad et al. 2014; Rahim et al. 2014). The increased burden of non-communicable diseases in Arab countries could be attributed to several factors. No doubt that modernization, tobacco smoking, health awareness, economic and financial pressuring factors, stress of the unstable and violent political conditions, and inadequate physical activity are among other important contributing factors to the rise of non-communicable diseases in Arab countries (Alwan 1994; Akl et al. 2011; Bull and Dvorak 2013; Maziak et al. 2013; Mokdad et al. 2014). However, nutritional factors and transition in nutritional habits maybe the major contributing factor for the rise in non-communicable diseases in Arab countries. Recently published review articles by Musaiger et al. have described the contribution of current nutritional problems among Arabs and its paramount importance and link to several common non-communicable diseases in Arab countries (Musaiger 2011; Musaiger and Al-Hazzaa 2012). The authors concluded that intervention programs to prevent non-communicable diseases are urgently needed. Such programs need to focus on promoting healthy diet and healthy eating practices in addition to promoting changes in life style pertaining to physical activity (Musaiger and Al-Hazzaa 2012; Musaiger et al. 2013). Similar studies linking nutritional habits and patterns with the rise in non-communicable diseases in Arab countries have been published and demanded urgent national monitoring of factors pertaining to troubling trends of non-communicable diseases in Arab communities (Ng et al. 2011; Musaiger et al. 2012a). Other published article have described the role of nutrition and Arab genetics in emergence of chronic diseases in Middle East and North Africa region (Fahed et al. 2012).

The results of our study showed that journals in the field of chemistry, food science and general nutrition have a good share from nutrition and dietetics publications from Arab countries. It is noteworthy that top 10 journals for publications in nutrition and dietetics from Arab countries did not include any journal in the field of clinical nutrition. In contrast, the worldwide list of top 10 journals for nutrition and dietetics included two clinical nutrition journals, particularly, the American Journal of Clinical Nutrition and the European Journal of Clinical Nutrition. The difference in the top 10 list journals between Arabs and worldwide reflects differences in research areas and research interest. It was obvious that health and clinically – related journals do not have big share of publications from Arab countries.

To the best of author’s knowledge, this is the first bibliometric study in the field of nutrition and dietetics from Arab countries and does establish a baseline data for future analysis and comparison. Our study is not without limitations, most of which are the same as those of studies performed in other biomedical fields (Sweileh et al. 2014a; Sweileh et al. 2014c,b). First of all, our study is limited by the fact that articles published in journals outside the WoS database were not included. Another limitation is that some publications from Palestine may be affiliated with Israel. Therefore, research activities from Israel were actually from Palestine.

Our study showed that interest in nutrition and dietetics research is relatively recent in Arab countries. Focus of nutrition research in Arab countries is mainly toward food technology and chemistry with lesser activity toward nutrition-related health research. Arab researchers, particularly in countries with high prevalence rates of obesity, diabetes mellitus, and cancer need to invest in more nutrition research in these fields. International cooperation in nutrition research will definitely help Arab researchers in implementing nutrition research that will lead to better national policies regarding nutrition.