A bibliometric analysis of a decade’s research on metabolic dysfunction-associated steatotic liver disease in the Arab world

Abstract

Background:

Metabolic dysfunction-associated steatotic liver disease (MASLD) presents a significant global health challenge, with the Arab region exhibiting a markedly higher prevalence. We aim to evaluate MASLD research output, collaboration patterns, and funding impact in the Arab region over the last decade.

Methods:

We conducted a bibliometric analysis of MASLD research in 22 Arab countries (2014–2023) using Clarivate Analytics’ InCites. Data on MASLD prevalence were extracted from the Global Burden of Disease, while population and economic data from the World Bank. We assessed MASLD-related publications, prevalence, collaboration patterns, and citation and funding impact.

Results:

Between 2014 and 2023, Arab countries contributed 844 publications (3.3% of global MASLD research). We identified positive correlations between MASLD-related publications and gross domestic product (GDP) (r_s = 0.825, P < 0.001), age-standardized prevalence (r_s = 0.627, P = 0.002), and population size (r_s = 0.509, P = 0.016). International collaborations accounted for 48.7% of these publications, with a citation impact of 15.7 compared to the global average of 23.7. Arab-funded MASLD-related publications constituted 19.4% of MASLD publications in the Arab world versus 42.3% globally funded. Citation impacts were similar between Arab-funded (30.6) and globally funded publications (30.3). Of the top 10 countries globally with the highest GDP, 47.8% of the MASLD publications received funding, yielding a citation impact of 33.5.

Conclusion:

Despite the high MASLD prevalence, Arab countries exhibit lower research output, impact, and funding compared to global levels. Increased regional collaboration and investment in MASLD research are critical to addressing this disparity.

INTRODUCTION

Nonalcoholic fatty liver disease (NAFLD) is a global health concern and is recognized as a silent epidemic.[1] NAFLD covers a range of liver conditions, ranging from simple steatosis (accumulation of fat) to nonalcoholic steatohepatitis (NASH), which is a more severe form associated with inflammation and liver cell damage. Progression of NASH can lead to fibrosis, cirrhosis, and hepatocellular carcinoma.[2,3] The seriousness of NAFLD is highlighted by its potential to cause significant liver-related morbidity and mortality. Lifestyle factors such as diet, physical activity, and metabolic factors contribute to the development and progression of NAFLD, making it a multifactorial condition that requires comprehensive management strategies.[4] Interestingly, the terminologies and definitions of NAFLD have evolved over the years. A term—metabolic dysfunction-associated fatty liver disease (MAFLD)—was proposed to emphasize the metabolic underpinnings of the condition. In 2023, a Delphi consensus statement issued by multiple societies introduced the term “metabolic dysfunction-associated steatotic liver disease (MASLD)” as a new, more representative term for NAFLD. This renaming initiative aims to reduce the stigma associated with the words “alcoholic” and “fatty,” while more accurately reflecting the complex metabolic factors influencing the disease.[5]

According to the 2019 Global Burden of Disease (GBD) data from the Institute for Health Metrics and Evaluation (IHME), the global age-standardized MASLD prevalence was 15.7%. In Arab countries, the average age-standardized MASLD prevalence was 27.2%, ranging from 13.5% to 36.2%.[6] This high prevalence is attributed, in part, to rapidly changing lifestyles, increased rates of obesity, and metabolic syndrome.[7] These changes position MASLD as not only a health crisis but also as a burden with significant economic implications for the region.[8,9] However, despite its growing prevalence, there has been no comprehensive examination of the research efforts on MASLD in Arab countries.

A recent bibliometric analysis of medical research in the Arab world found that the region contributes 2.72% of global research publications, with a citation impact of 11.98, nearly equal to the global average of 12.02. Given the high prevalence and burden of MASLD in the Arab region, we hypothesize that the MASLD research output should surpass this share of global medical publications and demonstrate a higher citation impact, reflecting the significance of the disease.[10] A previous global bibliometric study on MASLD research highlighted a considerable increase in articles about MASLD, which correlates with its growing prevalence and associated factors, such as metabolic syndrome. Furthermore, comparative epidemiological studies across different regions and populations suggest potential improvements in preventing and managing MASLD.[11]

Therefore, in this study, we aim to conduct a bibliometric analysis of MASLD research from the Arab world, covering the period from 2014 to 2023, aiming to systematically examine publication outputs, patterns, and impacts within MASLD-related literature. This analysis will help identify the current state, gaps, and opportunities for future research in addressing MASLD within the region.

MATERIALS AND METHODS

Study design

We undertook a bibliometric analysis of research on MASLD in the Arab world utilizing Clarivate Analytics’ InCites, the Web of Science (WoS) Database, and Journal Citation Report.[12] InCites helps evaluate research performance and benchmarking against global standards, including content from the Emerging Sources Citation Index (ESCI). The ESCI features scholarly peer-reviewed journals under evaluation for potential inclusion in the WoS Core Collection. InCites, with its user-friendly interface and advanced analytics, converts complex data into actionable insights, enhancing the accuracy and efficiency of research evaluation.[13]

Eligibility criteria

The search for the bibliometric study focused on MASLD research in 22 Arab countries, including Algeria, Bahrain, Comoros, Djibouti, Egypt, Iraq, Jordan, Kuwait, Lebanon, Libya, Mauritania, Morocco, Oman, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen.[14] From the InCites, we filtered the data by “Research area” and focused on “Citation topics,” which are groups of citations created by an algorithm. These topics are sorted into three levels based on their content (macro, meso, and micro).[15] Starting from the macro level, we chose “clinical and life sciences.” Moving to the meso level, we focused on “hepatitis” and ultimately investigated the micro level, “NAFLD,” which includes studies published under NAFLD, MAFLD, and MASLD. We retrieved all publications and verified if the search results included all studies given the evolving terminology in the field.

We limited the search to the last decade, from 2014 to 2023. We utilized the InCites dataset, updated on January 25, 2024, which includes WoS content indexed through December 31, 2023. To ensure inclusivity, we also included documents from the ESCI. For publication types, only “articles” and “reviews,” as classified in the Handbook by Clarivate Analytics,[16] were considered since these are the most commonly used publication types for research evaluation. Clarivate defines articles as new and original research, while reviews, on the other hand, summarize previously conducted studies.[17]

We involved author affiliations from all kinds of institutions in the Arab world, excluding those not specifically mentioned in the authors’ affiliation as provided in the published article. No limits were applied to funding agencies and publication sources (i.e., journals) other than the inclusion criteria. For validation purposes, we conducted a thorough examination by one author to ensure accuracy and consistency, followed by discussions with two senior authors for input and decision.

Among the top 20 most productive institutions in the Arab world, the Egyptian Knowledge Bank held the first position in the counts of MASLD-related publications. However, it was omitted as it did not meet our set inclusion criteria for institution/affiliation. Furthermore, during data validation, we noted that the information for the “United States Department of Health and Human Services (USDHHS)” and the “National Institutes of Health (NIH)—United States of America (USA)” was identical across all indicators. Since the NIH is a division within the USDHHS, we treated them as a single entity.[18]

Electronic search and data collection

The data for this study were collected from three sources: Clarivate, IHME’s GBD, and World Bank DataBank.[6,12,19] The collected data included the number of publications, citation counts, citation impact (defined as the ratio of citation counts to the total number of publications), impact relative to the world (defined as the MASLD citation impact of publications compared to the global average; a value greater than 1 indicates outperformance of the global average, while a value less than 1 indicates underperformance), collaborations with national and international co-authors, funding agency name, country, publications in different quartiles of journals, top 10% cited publications, top 1% cited publications, first author, corresponding author, institution’s h-index (defined as the highest number “h” where there are at least “h” articles from the institution, each cited “h” times or more), institution name, organization type, journal name, publication source, and journal impact factor quartile. The definitions of all indicators can be found in the Handbook provided by Clarivate Analytics.[16]

We retrieved the most recent data on the prevalence of MASLD for all ages, and age-standardized prevalence rates from the IHME’s GBD. The predefined selection criteria for data extraction were as follows: the measure was specified as “prevalence”; the metric was reported in “percent”; the cause was the “total burden related to NAFLD”; the scope of location was limited to “22 Arab countries”; age categories included “age-standardized” and “all ages”; both sexes were considered; and we focused on the latest available data for the year “2019.”

We collected the latest socioeconomic data from the World Bank DataBank for the 22 Arab countries as of February 3, 2024. This included population size for 2022, GDP (in current US$), and economic classifications for 2022. However, for Yemen, we used GDP data from 2018, as it is the latest available. Finally, we matched data collected from the previously mentioned platforms with the Clarivate database, linking each dataset to its respective country.

We further analyzed the top 10 countries with the highest GDP (current US$ in 2021) to assess their MASLD publications from 2014 to 2023. Initially, we retrieved GDP data from the World Bank for all countries worldwide. We filtered the information to include only GDP data from 2021 to align with our analysis of the Arab world. We then ranked these countries from highest to lowest GDP. The top 10 countries identified based on this criterion were: (1) United States, (2) China, (3) Japan, (4) Germany, (5) India, (6) United Kingdom, (7) France, (8) Italy, (9) Canada, and (10) Republic of Korea.

Statistical analysis

The data analysis was conducted using the Statistical Package for Social Sciences (SPSS) version 29.0 (IBM Corp., N.Y., USA) and Microsoft Excel. Median, interquartile range (IQR), and range values were calculated for key indicators throughout the study to provide a comprehensive understanding of the data’s central tendency, variability, and distribution. The association between MASLD-related publications and variables like prevalence, GDP, and population count was examined using Spearman’s rank correlation coefficient (r_s), as the publication data were not normally distributed. The strength of its results was interpreted according to Chan.[20]

We evaluated countries based on various indicators related to MASLD research. These indicators include MASLD prevalence, publication counts per 1 million population, citation impact, Arab world’s publication share and collaboration proportions. Countries were ranked based on age-standardized MASLD prevalence and total research output. We also identified the proportion of publications that received more than 100 citations, comparing those from Arab countries to the global figure. We then identified the top funding agencies supporting MASLD research from Arab countries and ranked them based on funded publication counts. Furthermore, we identified all MASLD publications from the top 10 countries with the highest GDP and further categorized MASLD-funded publications. Subsequently, we calculated the proportion of funded publications among all MASLD publications from these countries. In addition, we identified and compared the 20 most productive institutions in the Arab world and globally, ranking them by MASLD-related publications and citations to provide insights and benchmark the performance of Arab institutions against top global institutions. Lastly, we identified the top 10 journals publishing MASLD research by researchers affiliated with institutions in the Arab world, ranking them by publication counts. Journals were described based on the proportion of publications from Arab countries and citation impact.

Ethics

Since this research exclusively relies on publicly available data from online sources and does not involve direct interaction with human subjects, institutional ethics approval was not required.

RESULTS

MASLD research output and prevalence

An overview of MASLD-related publications from 2014 to 2023 and the prevalence of MASLD in Arab countries are presented in Table 1. Arab countries contributed 844 publications (3.3%) out of 25,902 publications globally, with a median of 12 MASLD-related publications per country (range: 0 to 487). Additionally, Figure 1 illustrates the annual MASLD research output from Arab countries compared to the global output. Both Arab countries and the global research landscape experienced an increase in MASLD-related publications from 2014 to 2023, with a peak in 2021. Arab countries showed an increase of 82 publications per year from 2014 to 2023, while globally, the increase was 1,668, resulting in a 109.5% growth for global MASLD research.

Table 1.

Total MASLD research productivity by Arab countries from 2014 to 2023. Countries ranked by number of MASLD publications

Ranking among Arab countries	Country	Publication (N)	Age-standardized MASLD prevalence (%)†	All ages MASLD prevalence (%)†	Population (N)‡	Publications per 1 million population§	Publications’ Arab world share (%)	Citations (N)	Citation impact||
1	Egypt	487	36.2	32.4	110,990,103	4	57.7	9,397	19.30
2	Saudi Arabia	257	32.0	34.4	36,408,820	7	30.5	3,245	12.63
3	United Arab Emirates	46	32.1	40.7	9,441,129	5	5.5	1,171	25.46
4	Iraq	32	28.3	23.9	44,496,122	1	3.8	174	5.44
5	Qatar	29	35.5	41.1	2,695,122	11	3.4	389	13.41
6	Lebanon	24	28.2	29.3	5,489,739	4	2.8	246	10.25
7	Jordan	23	31.1	27.5	11,285,869	2	2.7	426	18.52
8	Algeria	20	28.3	28.1	44,903,225	0	2.4	240	12.00
9	Morocco	17	28.5	28.8	37,457,971	0	2.0	289	17.00
10	Sudan	15	18.8	13.5	46,874,204	0	1.8	245	16.33
11	Kuwait	13	33.9	38.0	4,268,873	3	1.5	141	10.85
12	Tunisia	11	28.6	31.7	12,356,117	1	1.3	197	17.91
13	Syria	9	28.6	27.5	22,125,249	0	1.1	154	17.11
14	Bahrain	6	31.6	38.2	1,472,233	4	0.7	149	24.83
15	Oman	5	30.4	31.3	4,576,298	1	0.6	85	17.00
16	Palestine	2	26.9	20.8	5,043,612	0	0.2	33	16.50
17	Yemen	1	21.7	15.2	33,696,614	0	0.1	1	1.00
17	Mauritania	1	21.5	15.5	4,736,139	0	0.1	1	1.00
17	Somalia	1	13.5	7.9	17,597,511	0	0.1	1	1.00
20	Libya*	0	29.5	31.3	6,812,341	-	0	N/A	N/A
20	Comoros*	0	18.3	15.8	836,774	-	0	N/A	N/A
20	Djibouti*	0	15.0	12.3	1,120,849	-	0	N/A	N/A
-	Arab World	844	-	-	464,684,914	2	-	13,265	15.72
-	World	25,902	15.7	16.6	7,950,946,801	3	-	612,929	23.66

Tied rankings are indicated by repeated numbers. *No MASLD publications from 2014 to 2023. ^†Source: IHME GBD (2019). ^‡Source: World Bank DataBank (2022). ^§Publication per 1 million: publications/population ×1,000,000. ^||Citations count/publications from country

Figure 1.

Yearly MASLD-related publications in Arab countries versus the world from 2014 to 2023. The graph depicts the annual total number of MASLD publications in: a) all Arab countries combined compared to b) the global total between 2014 and 2023

Furthermore, Table 1 includes age-standardized prevalence rates for MASLD in all Arab countries. Among the 22 Arab countries, 20 had higher age-standardized MASLD prevalence rates than the global average (15.7%), with only Djibouti and Somalia below it.

MASLD-related publications per population

MASLD-related publications per population are summarized in Table 1. The median number of publications per 1 million population in Arab countries was 1 (range: 0–11). Qatar ranked highest with 11 MASLD-related publications per 1 million population, followed by Saudi Arabia with seven. Arab countries had two publications per 1 million population, compared to three globally. Egypt contributed the largest proportion of publications within the Arab world at 57.7%, followed by Saudi Arabia at 30.5%. Additionally, among Arab countries, Egypt accounted for the highest proportion of MASLD-related publications on a global scale, at 1.9%, followed by Saudi Arabia at 1.0%. The median number of citations for global MASLD-related publications per country was 179 (range: 1–9,397). The total citation impact for Arab countries was 15.72, compared to the global citation impact of 23.66.

Correlation with MASLD-related publication count

We assessed the relationship between the number of MASLD-related publications and MASLD prevalence [Figure 2a and b]. The Spearman correlation coefficient (r_s) was 0.560 (P = 0.007) for MASLD prevalence (all ages), indicating a fair positive correlation, and 0.627 (P = 0.002) for age-standardized MASLD prevalence, indicating a moderately strong positive correlation.

Figure 2.

Correlation between a) All ages MASLD prevalence, b) Age-standardized MASLD prevalence, c) Gross domestic product (GDP), and d) Population with MASLD-related publication counts in Arab countries from 2014 to 2023. *Denotes countries with zero MASLD publications from 2014 to 2023

Additionally, Figure 2c illustrates a very strong positive correlation between GDP (current US$) and the number of MASLD-related publications from Arab world countries, with an r_s of 0.825 (P < 0.001). In Figure 2d, we identified a fair positive association between population size and MASLD-related publication count in Arab countries, with an r_s of 0.509 (P = 0.016). Table S1 provides additional details, including the median, IQR, and range values for the selected variables.

Table S1.

Spearman’s rho correlation coefficient (r_s) between continuous variables and MASLD publications count in the Arab countries from 2014 to 2023

Variables	Spearman’s rho correlation coefficient (rs) with MASLD publications count	P	Median	IQR	Range
All ages MASLD prevalence*	0.560	0.007	28.5	15.7 – 32.9	7.9 – 41.1
Age-standardized MASLD prevalence*	0.627	0.002	28.6	21.7 – 31.7	13.5 – 36.2
GDP in Millions (current US$)†	0.825	<0.001	43,047.26	16,041.43 – 167,537.30	1,296 – 874,156
Population count (2022)†	0.509	0.016	10,363,499	4,499,441.75 – 36,671,107.75	836,774 – 110,990,103

GDP, gross domestic product; IQR, interquartile range (25^th-75^th percentile); MASLD, Metabolic dysfunction-associated steatotic liver disease; US$, United States dollar (2021 data, except Yemen-2018). *Source: IHME GBD (2019). ^†Source: World Bank DataBank

Citation impact of MASLD research

Figure 3 compares the number of MASLD-related publications to the citation impact ratio of Arab research relative to the world average. Although Egypt and Saudi Arabia had the highest number of MASLD-related publications, their relative impact ratios (0.82 and 0.53, respectively) were below the global average (world citation impact: 23.66 with a ratio of 1.00). Only two Arab countries were above the global average: the United Arab Emirates, with the highest impact relative to the world for MASLD-related publications at 1.08, followed by Bahrain at 1.05. Additionally, 2.6% of MASLD-related publications from Arab countries received more than 100 citations, compared to 4.9% globally.

Figure 3.

Total number of MASLD-related publications in Arab world countries and their impact relative to the world (2014-2023). Countries ranked from left to right in ascending order by their impact relative to the world. Impact relative to global average: Country’s MASLD citation impact divided by world baseline (23.66). Value >1 outperforms global average, <1 underperforms. Absent: Libya, Comoros, Djibouti lacked MASLD publications past decade. Single publication may involve researchers from multiple Arab countries

National and international collaborations

Table 2 presents the collaboration on MASLD-related publications with domestic and international researchers among Arab countries. MASLD-related publications by a single institution accounted for 28.31%, almost 23% of the publications included national collaboration, and 48.70% featured international collaborations. Among Arab countries with over 10 MASLD-related publications, Sudan had the highest proportion of international collaboration at 93.33% of MASLD-related publications, followed by the United Arab Emirates at 89.13%.

Table 2.

Collaboration on MASLD publications with national and international researchers affiliated to Arab world countries. Countries ranked by total research output

Country*	Publication (N)	Single institution publications		Publication with national collaboration†		Publications with international collaborations‡
		n	%	n	%	n	%
Egypt	487	153	31.42	146	29.98	188	38.60
Saudi Arabia	257	45	17.51	22	8.56	190	73.93
United Arab Emirates	46	5	10.87	0	0.00	41	89.13
Iraq	32	8	25.00	10	31.25	14	43.75
Qatar	29	7	24.14	2	6.90	20	68.97
Lebanon	24	5	20.83	1	4.17	18	75.00
Jordan	23	4	17.39	2	8.70	17	73.91
Algeria	20	1	5.00	5	25.00	14	70.00
Morocco	17	2	11.76	3	17.65	12	70.59
Sudan	15	1	6.67	0	0.00	14	93.33
Kuwait	13	1	7.69	1	7.69	11	84.62
Tunisia	11	5	45.46	2	18.18	4	36.36
Syria	9	1	11.11	0	0.00	8	88.89
Bahrain	6	0	0.00	0	0.00	6	100.00
Oman	5	1	20.00	0	0.00	4	80.00
Palestine	2	0	0.00	0	0.00	2	100.00
Somalia	1	0	0.00	0	0.00	1	100.00
Yemen	1	0	0.00	0	0.00	1	100.00
Mauritania	1	0	0.00	0	0.00	1	100.00
Arab world	844	239	28.31	194	22.99	411	48.70

*Absent Arab countries in tables: Libya, Comoros, Djibouti, lacked MASLD publications past decade. ^†Publications: ≥2 authors, different organizations/institutions, all same country. ^‡Publications: ≥1 international co-author

Funding

Table 3 shows the funding agencies supporting MASLD research in Arab countries. Among the top 10 funding agencies, four are from Arab countries, with two each from Saudi Arabia and Egypt. The other six include three from the United States, one from Australia, and two from Europe. The median number of MASLD-related publications funded by these top 10 agencies was 10.5 (range: 7–24). The top funded agency for MASLD research in the Arab world was the USDHHS/NIH—USA, funding 24 publications, followed by the Science and Technology Development Fund from Egypt with 21 publications, and King Saud University from Saudi Arabia with 16 publications. In total, 164 MASLD-related publications in the region were funded (19.4% of all MASLD-related publications in the Arab world) with a citation impact of 30.6, compared to 10,926 funded MASLD-related publications globally (42.3% of global MASLD-related publications), with a citation impact of 30.3. Arab MASLD publications account for only 1.5% of all funded MASLD research globally.

Table 3.

Top 10 funding agencies supporting MASLD research from Arab Countries (at least one of the co-authors from one of the Arab countries): 2014–2023. Ranked by number of funded MASLD publications

Rank	Funding agency name, Country/region	Funded publications (N)	Citations (N)	% Of publications in Q1 journals	% Of first author from Arab countries	% Of corresponding author from Arab countries	% Of international collaboration	Citation impact*	Impact relative to the world†
1	United States Department of Health & Human Services/National Institutes of Health (NIH), United States of America	24	686	75.00	37.50	20.83	100.00	28.58	1.21
2	Science and Technology Development Fund (STDF), Egypt	21	109	7.14	95.45	95.45	14.29	5.19	0.22
3	King Saud University, Saudi Arabia	16	182	18.18	54.55	59.09	62.50	11.38	0.48
4	National Health and Medical Research Council (NHMRC) of Australia, Australia	13	23,58	83.33	40.00	0.00	100.00	181.38	7.67
5	National Research Centre (NRC), Egypt	12	84	0.00	100.00	100.00	0.00	7.00	0.30
6	European Union (EU), Europe	9	216	71.43	38.46	15.38	100	24.00	1.01
7	Gilead Sciences, United States of America	7	173	57.14	44.44	22.22	85.71	24.71	1.04
7	German Research Foundation (DFG), Germany	7	313	71.43	42.86	14.29	100.00	44.71	1.89
7	Princess Nourah bint Abdulrahman University, Saudi Arabia	7	31	0.00	56.25	50.00	85.71	4.43	0.19
7	NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK), United States of America	7	123	80.00	71.43	57.14	100.00	17.57	0.74
-	Arab world	164	5,019	49.18	N/A	N/A	71.95	30.60	1.29
-	World	10,962	332,266	54.64	N/A	N/A	26.79	30.31	1.28

*Number of citations divided by the number of publications funded by the agency. ^†Impact relative to the global average is equal to the agency’s citation impact divided by the world citation impact baseline

In contrast, the top 10 countries with the highest GDP produced a total of 20,216 MASLD publications from 2014 to 2023. Among these publications, 9,661 (47.8%) received funding, with a citation impact of 33.5.

Institutions’ MASLD research productivity

Out of the top 20 institutions within the Arab countries, 17 (85%) were classified as academic institutions, one (5%) was a health institution, one (5%) was a research institute, and one (5%) was a governmental body. Fifteen of these institutions were from Egypt, and five were from Saudi Arabia. The median number of publications across the top 20 institutions in the Arab countries was 35.5 (range: 19–149), with a median of 471 citations (range: 183–3,176). We compared our findings for the top 20 institutions that published MASLD-related research in the Arab countries to the top 20 institutions that published MASLD-related research globally. We found that 12 (60%) were classified as academic institutions, five (25%) as health institutions, and three (15%) as government institutions. Among these institutions, 12 were from the United States, three From France, two from England, one from Australia, one from Hong Kong, and one from Italy. Out of these top 20 institutions that published MASLD-related research globally, the median number of MASLD publications was 372 (range: 152–921), with a median of 22,849 citations (range: 18,437–54,478).

Table S2 presents the proportion of each institution’s national contribution and the citation indicators for the most productive institutions in the Arab world, limited to the top 10 most cited. The median number of citations was 735 (range: 541–3,176), and the median proportion of national contribution per institution was 11.1% (range: 5.5%–30.6%). In comparison, the median number of citations among the top 10 most cited institutions globally, out of those 20 most productive institutions, was 26,715 (range: 19,346–43,840), and the median proportion of national contribution per institution was 7.3% (range: 2.5%–66.5%).

Table S2.

National contribution and citations for the most productive institutions in Arab countries: 2014–2023. Ranked by Citation counts

Rank	Institution name	Organization type	Country	Citations (N)	MASLD publications per institution	% National contribution	Citation impact*	h-index†
1	Mansoura University	Academic	Egypt	3,176	70	14.37	45.37	20
2	Minia University	Academic	Egypt	2,936	42	8.62	69.90	15
3	Cairo University	Academic	Egypt	1,829	149	30.60	12.28	23
4	King Saud University	Academic	Saudi Arabia	781	68	26.46	11.49	15
5	Ain Shams University	Academic	Egypt	750	67	13.76	11.19	14
6	Menofia University	Academic	Egypt	720	39	8.01	18.46	12
7	Beni Suef University	Academic	Egypt	654	27	5.54	24.22	14
8	King Abdulaziz University	Academic	Saudi Arabia	580	35	13.62	16.57	11
9	Tanta University	Academic	Egypt	557	36	7.39	15.47	14
10	Helwan University	Academic	Egypt	541	42	8.62	12.88	13

Top 20 institutions by MASLD publications. *Citations count divided by institution’s publications. ^†h-index of an institution is the highest number ‘h’ where there are at least ‘h’ articles from the institution, each cited ‘h’ times or more

Out of the top 10 most productive Arab institutions, the median proportion in the top 10% of MASLD-related publications by citations was 11.50% (range: 7.14%–26.19%), with Minia University in Egypt (26.19%) and Taif University in Saudi Arabia (21.05%) having the highest proportion. For the top 1% by citations, no publications met the threshold at the median level (range: 0.00%–4.76%) [Table S3].

Table S3.

Top MASLD publications by the most productive institutions in Arab countries. Ranked by 10% most cited

Rank	Institution name	Country	% Of publications in the top 10% by citation	% Of publications in the top 1% by citation	% Of publications in Q1	MASLD publication per institution	% Of international collaboration	% Of first author from the institution	% Of corresponding author from the institution
1	Minia University	Egypt	26.19	2.38	56.25	42	71.43	45.24	30.95
2	Taif University	Saudi Arabia	21.05	0.00	33.33	19	84.21	42.11	31.58
3	King Faisal Specialist Hospital & Research Center	Saudi Arabia	20.00	2.86	18.18	35	88.57	20	14.29
4	Benha University	Egypt	13.04	0.00	14.29	23	52.17	56.52	39.13
5	Helwan University	Egypt	11.90	4.76	26.47	42	40.48	16.67	30.95
6	Beni Suef University	Egypt	11.11	0.00	36.36	27	77.78	37.04	25.93
7	Menofia University	Egypt	10.26	0.00	20.00	39	48.72	51.28	46.15
8	Mansoura University	Egypt	8.57	4.29	17.65	70	48.57	55.71	50.00
9	Tanta University	Egypt	8.33	0.00	33.33	36	33.33	55.56	52.78
10	Assiut University	Egypt	7.14	0.00	5.00	28	39.29	39.29	42.86

Most productive institutions have been limited to the top 20 in number MASLD of publications

The median proportion of MASLD-related publications by researchers affiliated with institutions in the Arab region in the first quartile (Q1) journals was 23.24% (range: 5.00%–56.25%). The median proportion of international collaboration was 50.45% (range: 33.33%–88.57%), with King Faisal Specialist Hospital and Research Center in Saudi Arabia having the highest proportion.

Medical research journals

We summarized in Table S4 the leading journals for MASLD-related publications by Arab researchers between 2014 and 2023. We listed 11 journals, including a tie for the tenth position. Of these journals, three originated from Arab countries—two from Egypt and one from Saudi Arabia—while two were from England, one from France, one from the Netherlands, and four from the United States. The median impact factor of these journals was 2.4 (range: 0.8–14.0), and the median citation impact was 11.5 (range: 0.2–152.5). The median number of MASLD-related publications in these journals was 100 (range: 18–541). Among these journals, three were classified as Q1, one as Q2, one as Q3, two as Q4, and four were not classified.

Table S4.

Top 10 journals publishing MASLD research by Arab researchers (out of 415 journals). Ranked in descending order by number of publications

Rank	Journal name	Publication source	Publications from Arab countries (N)	Total publication (N)*	% Of publications from Arab countries†	Citations (N)	JIF quartile ‡	Journal Impact Factor‡	Citation impact§
1	European Journal of Gastroenterology & Hepatology	United States of America	25	251	10.0	235	Q4	2.1	9.4
2	Arab Journal of Gastroenterology	Netherlands	22	30	73.3	254	Q4	1.4	11.5
3	Egyptian Journal of Radiology and Nuclear Medicine	Egypt	16	18	88.9	23	N/A	1.0	1.4
4	Egyptian Liver Journal	Egypt	13	18	72.2	3	N/A	0.8	0.2
5	Hepatology	United States of America	11	427	2.6	1,677	Q1	14.0	152.5
5	Saudi Journal of Gastroenterology	Saudi Arabia	11	25	44.0	168	Q3	2.7	15.3
7	Scientific Reports	England	10	541	1.8	115	Q2	4.6	11.5
7	World Journal of Hepatology	United States of America	10	168	6.0	342	N/A	2.4	34.2
7	Biomedicine & Pharmacotherapy	France	10	129	7.8	132	Q1	7.5	13.2
10	Life Sciences	England	9	91	9.9	82	Q1	6.1	9.1
10	Cureus Journal of Medical Science	United States of America	9	100	9.0	23	N/A	1.2	2.6

JIF, Journal Impact Factor. *Publications from all world countries. ^†MASLD publications by Arab researchers divided by total MASLD publications per journal. ^‡Source: Journal Citation Reports (2022). ^§Citation impact: Citations count divided by journal publications

DISCUSSION

This bibliometric analysis found that despite relatively high MASLD disease prevalence in Arab countries, research output, impact, and funding were low compared to the rest of the world. The prevalence and progression of MASLD within the Arab region are closely linked to metabolic disorders, notably diabetes and obesity. This correlation is underscored by prior research findings indicating a significantly higher prevalence in the Arab region, mainly the Middle East and North Africa, compared to global averages.[21,22,23,24] These observations emphasize the pressing need for focused investigations and innovative healthcare strategies tailored to address the specific challenges MASLD poses in this region.

Our bibliometric analyses found a significant increase in MASLD-related research output in the Arab world, mirroring the global rise in publications reported in previous studies.[25,26] The proportion of MASLD-related publications from the Arab world accounts for 3.3% of global MASLD publications, which is relatively higher than the reported 2.7% share of all medical research from the Arab world.[10] Moreover, the citation impact of MASLD research from Arab countries was lower than the global citation impact for MASLD-related publications (15.7 vs. 23.7). However, Arab MASLD publications showed a slightly higher citation impact compared to both medical research publications from the Arab world and global publications (15.7 vs. 11.98 vs. 12.02).[10] These findings could underscore the growing importance of MASLD research and its tangible impact, both regionally and globally.

A similar trend is observed in the Indian subcontinent, where research output remains low despite a high prevalence of MASLD. Between 2001 and 2022, the region contributed only 3.4% of global MASLD research, with India accounting for the majority of these publications. Similar to the Arab region, funded MASLD research in the Indian subcontinent accounted for a small proportion of total research output (15.8% in the Indian subcontinent vs. 19.4% in the Arab region). Moreover, international research collaboration in the Indian subcontinent remains limited (24.6% vs. 48.7% in the Arab region), and most publications receive fewer citations. Funding and international collaboration were key factors driving higher-impact research, underscoring the need to improve research networks and funding in both regions.[27]

It is also noteworthy that most publications from the Arab world, among the top 10 publishers, appeared in journals with relatively low impact factors, with a median journal impact factor of 2.4 (range: 0.8–14.0). This highlights an opportunity to enhance the global visibility and reach of MASLD research. Factors such as preference for regional journals or limited alignment with the focus of high-impact international journals may be influencing current publication patterns. Strengthening international collaborations, increasing research funding, and encouraging the dissemination of high-quality studies in globally recognized journals could further elevate the impact of MASLD research from Arab countries.[28,29]

The observed correlations between MASLD prevalence, socioeconomic indicators, and the number of publications shed light on the complex relationship between liver disease research and socioeconomic conditions. The positive relationship between MASLD prevalence and the number of publications suggests a growing interest and investment in MASLD-related research. Moreover, the strong positive correlation between GDP and the number of MASLD-related publications underscores the influence of economic resources on research productivity and dissemination. Countries with higher GDPs may possess greater funding opportunities, research infrastructure, and access to advanced technologies, leading to better research output. Similarly, the association between population size and the number of MASLD-related publications highlights the role of population demographics in shaping research priorities and allocating resources toward addressing public health challenges. These findings emphasize the importance of addressing socioeconomic disparities and fostering international collaboration to advance research and interventions to mitigate the global burden of MASLD.[29,30,31]

In examining the disparities in publication output across Arab countries, it is noteworthy that lower-middle-income countries like Comoros and Djibouti have zero publications, indicating potential challenges in research infrastructure and funding availability. Similarly, despite being an upper-middle-income country with a relatively high prevalence of MASLD, Libya has no publications. The absence of publications from these countries suggests the need for targeted interventions to strengthen research capacity and enhance collaboration, even in countries with more favorable economic resources.[30,32]

Interestingly, we found that the citation impact for MASLD-related publications with funding was nearly the same for Arab and global publications, at 30.6 and 30.3, respectively. The significant difference in the Arab region, where the citation impact nearly doubles with financial support (15.7 for all MASLD-related publications versus 30.6 for funded MASLD-related publications), underscores the crucial role of funding in enhancing research quality and influence. Moreover, insights into funding trends underscore the vital contribution of international funding agencies, particularly the NIH, in ensuring sustained and diversified research support.[33,34]

Multiple studies emphasize the crucial role of international collaborations in enhancing research impact within the Arab world. Countries such as the United Arab Emirates and Bahrain achieved research impact above the global average, likely benefiting from international research networks.[26,33]

Given the high prevalence of MASLD in Arab countries, addressing the multifaceted challenges posed by this disease requires concerted efforts from researchers, policymakers, and healthcare practitioners. By prioritizing research initiatives, fostering interdisciplinary collaborations, and ensuring equitable access to resources, we can enhance our understanding of MASLD and develop effective preventive and therapeutic interventions to mitigate its impact on public health.

Despite the interesting results, this study has several limitations. The reliance on publicly available databases, like Clarivate Analytics for bibliometric analysis, IHME GBD for MASLD burden, and the World Bank for socioeconomic factors, introduces potential biases. Relying on a single source for bibliometric analysis may miss valuable insights from other sources not indexed on the chosen platform. Variations in data reporting standards across different countries and institutions may affect the accuracy of disease burden and socioeconomic analyses. Additionally, focusing primarily on articles and reviews from Clarivate Analytics may exclude conference proceedings or grey literature, potentially affecting the comprehensiveness of the analysis. We were also unable to categorize the studies by design (e.g., randomized controlled trials, cohort studies, cross-sectional studies) or define metrics for each type, which further limits the depth of the analysis. The analysis predominantly includes publications indexed in Web of Science (via Clarivate Analytics’ InCites), which predominantly features studies available in English-language. While some non-English studies are included in In Cites, Arabic-language publications are largely underrepresented, leading to a potential language bias. Finally, while citation counts and impact factors are useful metrics for assessing research impact, they may not fully capture the quality or significance of individual publications, thus limiting the evaluation of MASLD research.

Despite these limitations, the study offers a thorough analysis of MASLD research in Arab countries over a decade, using bibliometric analysis to offer valuable insights into publication trends and collaboration patterns. The study’s findings have significant implications for public health policy and research funding, guiding resource allocation and supporting initiatives to address the MASLD burden in the region. Additionally, the study underscores the importance of partnerships to advance MASLD research in Arab countries by highlighting the role of international collaboration in enhancing research impact. To amplify the impact of MASLD-related publications, it is crucial to invest in robust research infrastructure, training programs, and multidisciplinary collaborations, highlighting the importance of funding in this field.

In conclusion, our analysis of MASLD research in Arab countries from 2014 to 2023 reveals that despite the region’s significant disease burden, only 3.3% of global MASLD research came from Arab nations. We observed positive correlations between MASLD-related publications and socioeconomic indicators, with nearly half of Arab MASLD-related publications involving international collaborations. Additionally, funded MASLD-related publications showed a citation impact that is double that of all MASLD research. These findings underscore the importance of collaboration and targeted funding in advancing MASLD research in Arab countries and globally.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.