Mapping global research on environmental enteric dysfunction: A bibliometric study of trends and emerging themes

Abstract

Problem considered Environmental enteric dysfunction (EED) is a subclinical inflammatory disorder of the small intestine that results in nutrient malabsorption, stunting, impaired cognitive development, and adverse pregnancy outcomes. It disproportionately affects populations in low- and middle-income countries, where chronic exposure to enteric pathogens and poor sanitation is common. Despite growing recognition as a global health concern, EED remains poorly defined, with no standardized diagnostic tools. This bibliometric analysis examines research trends, leading contributors, and emerging themes to inform future research directions. Methods The study analyzed publications related to EED retrieved from the Scopus database, covering the period 1972 to 2024. Data cleaning was performed using OpenRefine. Keyword co-occurrence network analysis was conducted using VOSviewer, while trend and collaboration analyses were carried out in R Studio, and geographic visualization in Tableau. Results From 1972 to 2024, 484 publications on EED were identified, with an annual growth rate of 5.06%. Output increased markedly after 2010, driven by growing recognition of EED in child growth and malnutrition. The United States and the United Kingdom led publication output, while Bangladesh, Pakistan, and India were the most active LMICs, though their contributions remain low relative to disease burden. Research focus has shifted from basic pathology to multidisciplinary areas, including microbiota, biomarkers, and WASH-related determinants. Conclusion EED research has expanded over five decades, evolving from a focus on malnutrition to biomarkers and mechanistic studies. However, geographic imbalances persist, underscoring the need to strengthen research capacity, promote equitable collaborations, and translate mechanistic insights into scalable, context-appropriate interventions.

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