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Cover page of the Journal of Health Sciences


 
 Table of Contents  
REVIEW ARTICLE
Year : 2018  |  Volume : 11  |  Issue : 3  |  Page : 191-202

Global research trends of literature in sugar-sweetened beverages: 2000–2016


1 Department of Physiology, Pharmacology and Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
2 Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine

Date of Web Publication25-Sep-2018

Correspondence Address:
Prof. Ansam F Sawalha
Department of Pharmacology and Toxicology, College of Medicine and Health Sciences, Ans-Najah National University, Nablus, Palestine

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_2_18

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  Abstract 


BACKGROUND: Sugar-sweetened beverages (SSBs) are commonly used. The objective of this study was to analyze the quantity and quality of published literature on SSBs and present the results in a bibliometric format.
METHODOLOGY: Scopus database was used to retrieve documents from 2000 to 2015. Annual growth of publications, collaborations, geographic distribution, visualization and mapping of collaboration, author analysis, and top-cited articles will be presented and discussed.
RESULTS: The total number of worldwide publications on SSBs was 3345, published in 27 subject areas. More than half (58.30%) of the SSB publications were within the area of medicine. The number of publications gradually increased until 2013 followed by a steady state. The median of number of citations was 3 (0–14) per document. The annual growth rate of publications on SSBs dropped from 15.22 in 2001 to 1.00 in 2016. The total number of authors was 13,813, with a mean of 3.72 ± 0.72 authors per document. Most documents (2942, 87.95%) were multi-authored publications. The USA was the most productive country (1062; 31.75%) followed by the United Kingdom (234; 7%) and Brazil (171, 5.11%). Harvard University was the leading institution with 112 publications. The most commonly preferred journal for publishing was “Public Health Nutrition” with 81 publications. Half of the top ten preferred journals were in the field of nutrition.
CONCLUSION: Bibliometric analysis of literature on SSBs is one method to enrich literature and encourage health policymakers and nutrition specialists to take the case of SSBs one step further to limit the consumption of SSBs.

Keywords: ArcMap10.1, bibliometric, sugar-sweetened beverages, VOSviewer


How to cite this article:
Sweileh WM, Sawalha AF, Al-Jabi SW, Zyoud SH, Abutaha AS. Global research trends of literature in sugar-sweetened beverages: 2000–2016. Indian J Health Sci Biomed Res 2018;11:191-202

How to cite this URL:
Sweileh WM, Sawalha AF, Al-Jabi SW, Zyoud SH, Abutaha AS. Global research trends of literature in sugar-sweetened beverages: 2000–2016. Indian J Health Sci Biomed Res [serial online] 2018 [cited 2018 Dec 19];11:191-202. Available from: http://www.ijournalhs.org/text.asp?2018/11/3/191/242041




  Background Top


In the past two decades, obesity and diabetes had received a lot of focus from researchers in various scientific disciplines.[1],[2],[3],[4],[5] One of the major reasons for this was the escalating global prevalence of both obesity and diabetes to the extent that these two conditions became a global public health challenge.[6],[7],[8] Nutritional habits remain an important cause of obesity and consequently potential impaired glucose tolerance. Many published reports have associated consumption of sugar-sweetened beverages (SSBs) with various clinical conditions such as obesity, diabetes mellitus, dental caries, metabolic syndrome, cardiometabolic disorders, and several others.[9],[10],[11],[12],[13],[14],[15],[16] Despite several calls made by national and international health organizations to limit the intake of SSBs, the consumption of SSBs across various age groups is still enormous.[17],[18],[19] Several studies called for new regulations and taxes as methods to cut down the consumption of SSBs.[20],[21],[22],[23],[24] The public attitude toward regulating the consumption and purchase of SSBs was to endorse such regulations.[25] Among children, a study indicated that children are seeking for more education about the health effects of SSBs to reduce their consumption of SSBs.[26] Another study suggested that warning packaging labels could reduce the consumption of SSBs.[27] A study concluded that media could increase the level of awareness and education about the health effects of SSBs among the public and therefore help cut down consumption of sugary drinks through planned campaigns.[28]

The national and international quantity and quality of research on SSBs is an important indicator of the involvement of various countries as well as international health community on health-related issues. Research on SSBs can be used to fuel media with campaign data to endorse the reduction of SSB consumption. Analysis and assessment of research output in any topic can be carried out through bibliometric analysis which is defined as the use of statistical methods to analyze published literature. Therefore, the objective of this study was to carry out a bibliometric analysis of literature on SSBs. Specifically, annual growth of publications on SSBs, national and international collaborations, geographic distribution of publications, visualization of commonly encountered words, mapping of international collaboration, author analysis, and top-cited articles will be presented and discussed. To achieve this objective, literatures on SSBs present in Scopus database were retrieved. Scopus database, based on the authors' understanding, is the largest database for literature in social and medical fields. Scopus database had been successfully used to assess global research trends in previously published bibliometric studies.


  Methodology Top


Search strategy

In this study, SSB refers to liquids that are sweetened with added sugars and used as a social drink. Therefore, alcoholic and sugar-free drinks were not included in the current study. Examples of SSB that were used in this study included a list of terms used in published literature about SSBs.[17],[29],[30],[31],[32],[33] Furthermore, several systematic reviews on SSB included a common list of terms to describe SSBs.[23],[34],[35],[36],[37],[38],[39],[40] The search query that we used in Scopus appeared as follows:

([TITLE (“cordial drink” OR “squash drink” OR “sugar-sweetened beverages” OR “sugar beverages” OR “sweetened beverages” OR “soft drinks” OR “carbonated soft drinks” OR “fruitades” OR “fruit drinks” OR “sports drinks” OR “energy drinks” OR “sweetened iced tea” OR “carbonated drinks” OR “fruit drinks” OR “sweetened waters” OR “tea beverage” OR “fortified waters” OR “electrolyte drinks” OR “vegetable drinks” OR “non-alcoholic beverage” OR “caffeinated beverage” OR “caffeinated drink”)] OR [TITLE (beverage OR drink) AND TITLE-ABS-KEY (“sugar-sweetened beverage” OR “sugar beverage” OR “sweetened beverage” OR sugar OR sweetened)] AND NOT TITLE [“sugar-free” OR alcohol OR hydrogen OR wine]).

The terms used were arranged in the search query to minimize false-positive and false-negative results. Therefore, the list of terms was used in TITLE search and was endorsed by the term “sugar sweetened beverages” in TITLE-ABS-KEY. To avoid false positivity, the terms “sugar free,” “alcohol,” “wine,” or “hydrogen” were excluded from the results because articles containing such words in the title were found to be false positive based on a manual review of results by the authors. The time specified for the study was from the year 2000 until 2016. The word literature defined journal articles and therefore literatures available as books or book chapters were not included in the analysis. The limitation of search to journal articles was achieved through a special function available through the database used for this purpose, Scopus.

Bibliometric indicators and tools of analysis

Growth aspects of literature on SSBs were analyzed and presented. Such growth aspects include annual growth rate (AGR), doubling time (DT), and relative growth rate (RGR). Author analysis of literature on SSB was also presented and included information about the number of authors per document and proportion of single-authored versus multi-authored documents. International productivity and geographical distribution of literature on SSBs were presented using ArcGIS10.1 (ESsri, California, USA). Comparison of research productivity with SSB consumption in actively involved countries was made. Extent of international collaboration and number of collaborating countries for each of the top active countries were presented and tabulated. The international collaboration was further clarified by visualization using VOSviewer (version 1.6.8; Leiden University, the Netherlands) in which the extent of collaboration among any two selected countries can be visualized and converted into relative strength numbers called “link strength.” For qualitative analysis, the growth of citations, Hirsh-index (h-index), and impact factor (IF) were presented whenever appropriate. For each of the preferred journals which published most on SSBs, the IF, total citations, and citation per document were presented. For most active institutions and countries, total citations, citations per doc, and h-index were presented. To shed light on important terms most commonly encountered in SSB literature, VOSviewer was used to visualize these terms and were presented in a network visualization map. Finally, the most highly cited articles which represent the hallmarks in the field of SSBs will be cited and the content of these highly cited articles was discussed.

Features of scopus used in the analysis

Scopus has several features that allow easy presentation and analysis of the results. Scopus itself provides annual analysis of retrieved results and presents ranking of countries, institutions, authors, and source titles. For ranking of countries and institutions, Scopus uses the author affiliation in the article regardless of the position of the author in the article. Multi-authored articles in which all authors had the same country affiliation were counted once for that article. However, multi-authored articles in which authors had different country affiliation were counted once for each country present in the affiliation and therefore the total productivity of all countries might exceed 100% due to overlap in certain multi-authored articles. The same argument applies in ranking institutions/organization. For citation analysis, Scopus provides total citations for retrieved articles, h- index, and number of citations for each article.

Equations used in the analysis

Several equations and tools were used in this study. Such equations and tools include the following:

  1. VOSviewer: A software tool used for visualization of bibliometric networks [41]
  2. ArcGIS (ArcMap10.1): A geographic information system program.
  3. AGR = ([Ending Value − Beginning Value]/Beginning Value) × 100
  4. RGR: = (logeW2 − logeW1/(T2 − T1)[42],[43],[44]


  5. where logeW1: Log of initial number; logeW2: Log of final number after a specific period of interval; T2 − T1: The unit difference between the initial time and the final time.

  6. DT: Time required for the number of publications to double in number. DT = 0.693/RGR[42],[43],[44]
  7. Degree of collaboration = C = Nm/Nm + Ns[42],[43],[44]


  8. where Nm = number of multi-authored papers; Ns = number of single-authored papers

  9. Average author per paper = number of authors/number of papers
  10. Productivity per author = number of papers/number of authors
  11. Collaboration index = CI = number of authors/number of papers.[42],[43],[44]



  Results Top


Types of published documents and subject areas

The total number of worldwide publications on SSBs for the assigned study period was 3345 documents. The vast majority of published documents were research articles (2702; 80.78%). Approximately 1.02% of the published documents were conference papers. The various types of published documents on SSB and their corresponding frequencies are shown in [Table 1]. Author keyword co-occurrences are shown in the network visualization map [Figure 1]. As expected, the most commonly encountered author keywords were soft drinks, SSB, energy drinks, and caffeine which were shown prominently in the map. The keyword obesity was also a dominant author keyword in the publications. The published documents were distributed across 27 different subject areas listed in [Table 2]. More than half (58.30%) of the documents were within the subject area of medicine. A total of 375 (11.21%) documents on SSBs were within the subject area of chemistry.
Table 1: Types of retrieved documents (n=3345)

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Figure 1: Network visualization map of author keyword occurrences created by VOSviewer

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Table 2: Subject areas of retrieved documents (n=3345)

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Growth of publications and citations

[Table 3] shows the growth of publications with time. The number of published documents showed a gradual increase until 2013 followed by a steady state number of publications, with an approximate average of 401 documents per year. The gradual increase in the number of publications was paralleled and significantly correlated (P < 0.001, r = 0.851) by an increase in total number of citations [Figure 2]. The total cumulative citations was 56,701, with mean ± standard deviation of 16.95 ± 54.28 and a median of 3 (0–14) citations per document. The total number of pages of published documents was 18,887 with a mean of 5.74 ± 0.6 pages per document. The growth of publications was not significantly accompanied by an increase in the mean number of pages per document.
Table 3: Annual research productivity on sugar-sweetened beverages

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Figure 2: Growth of publications and total citations for retrieved documents in SSB

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[Table 4] shows growth analysis of publications. The AGR of publications dropped from 15.22 in 2001 to 1.00 in 2016. Similarly, the RGR of publications dropped from 0.77 in 2001 to 0.13 in 2016, while the DT increased >5 folds from 0.9 in 2001 to 5.33 in 2016. [Figure 3] shows the changes in RGR and DT across the study period. [Table 5] shows that there was a significant positive correlation between the number of annually published documents and the mean number of authors per document. The mean number of authors per document increased from 3 in 2000 to 5.19 authors per document in 2016. The total number of authors who participated in publishing retrieved documents was 13,813, a mean of 3.72 ± 0.72 authors per document. A total of 403 (12.05%) documents were single-authored publications, while the remaining documents (2942, 87.95%) were multi-authored publications. The total number of authors of MAP was 13,405, giving a mean CI of 4.1 ± 0.77 [Table 6].
Table 4: Growth analysis of sugar-sweetened beverage publications

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Figure 3: Relative growth rate (RGR) and doubling time (DT) of SSB publications

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Table 5: Author analysis of retrieved documents

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Table 6: Authorship analysis and author collaboration in retrieved documents

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Country productivity and international collaboration

[Figure 4] shows the geographical distribution of publications on a worldwide map created using ArcMap 10.1 program. Analysis of country productivity is presented in [Table 7]. The USA was the most productive country (1062; 31.75%) followed by the United Kingdom (234; 7%) and Brazil (171, 5.11%). Publications from the USA had the highest h-index (h-index = 83) followed by those from the UK (h-index = 38). The list of top ten productive countries included countries from North America, Latin America, Europe, Asia, and Australia. Canada had the highest percentage of publications (47.68%) with international collaboration followed by Australia (44.87%). However, in terms of quantity, the USA (219; 20.62%) had the highest number of articles with international collaboration. India had the lowest (12, 8.22%) international collaboration in terms of quantity or percentage. The extent of international collaboration among countries with a minimum productivity of forty documents is visualized in [Figure 5]. The visualization map indicated that most productive countries were clustered into three clusters with three different colors. The highest extent of collaboration was between the USA and the UK (total link strength = 38) followed by the USA and Canada (total link strength = 37), the USA and Mexico (total link strength = 28), and the USA and Australia (total link strength = 22). [Table 8] shows a list of top ten active institutions/organizations in publishing journal articles about SSBs. Harvard University was the leading institution with 112 publications on SSBs. Seven out of the top ten institutions were in the USA, while the remaining ones were in Brazil, Mexico, and Australia. The publications from Harvard University had the highest h-index followed by those from Brigham and Women's Hospital.
Figure 4: Geographical distribution of SSB publications created by ArcMap 10.1

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Table 7: Top ten productive countries and international collaboration

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Figure 5: International collaboration among countries with a minimum productivity of documents. The thickness of connecting line between any two countries is an indicator of extent of collaboration

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Table 8: Top ten productive institutions/organizations

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Preferred journals for sugar-sweetened beverage publications

The preferred journals for publishing documents on SSBs are shown in [Table 9]. The most preferred journal was “Public Health Nutrition” with 81 publications followed by “American Journal of Clinical Nutrition” with 73 publications (2.12%) and”Food Chemistry” with 49 publications (1.42%). Half of the top ten preferred journals were in the field of nutrition and two were in the field of food chemistry. All preferred journals for SSB publications had an IF of at least 1.0 as published by Journal Citation Report of 2015. Co-citation analysis of journals with a minimum total citations of 300 showed that SSB publications in American Journal of Clinical Nutrition had the highest number of citations and were commonly co-cited with Journal of American Diet Association (link strength = 4441), followed by JAMA (link strength = 3662), and Circulation (3296) [Figure 6].
Table 9: Top ten preferred journals for publishing documents in sugar-sweetened beverages

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Figure 6: Journal co-citation analysis for journal publishing documents in SSB and had a total minimum citation of 300. Journals with a connecting line means that they are co-cited together. The thickness of connecting lines is indicative of extent of co-citation

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Top-cited publications on sugar-sweetened beverages

Publications on SSBs with the highest citations are shown in [Table 10].
Table 10: Top twenty cited documents in sugar-sweetened beverages

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The highest number of citations obtained was 1395 (as of February 15, 2017) and the top-cited article was published in Lancet in 2001. Of the top twenty cited publications, eight were review articles and the remaining were research articles. Half of the top twenty cited articles discussed the relation between SSB and obesity and/or diabetes mellitus. One article of the top ten cited articles discussed the relation between SSB and gout. Four articles in the top twenty cited articles were published in American Journal of Clinical Nutrition, one in Diabetes Care, and one in Obesity Research.


  Discussion Top


In this bibliometric study, we sought to analyze the quantity and quality of publications on SSBs. Our study showed that health-related research aspects dominated the field of SSBs. In particular, negative nutritional aspects of SSB on body weight, diabetes, and cardiometabolic health were most commonly discussed. Although the AGR and RGR of SSB publications declined with time, the importance of the SSBs remained high as indicated by escalating the total number of citations with time, the IF of main journals publishing articles on SSB, and by the increased average number of authors per document with time, suggestive of increased interest and collaboration to publish about SSBs. The high h-index of SSB publications is also an indication of large number of citations received by SSB publications. In contrast to many previously published bibliometric studies in which North American and European countries dominated the top ten list,[65],[66],[67],[68],[69],[70],[71],[72] the SSB publications originated from different world regions and the top ten list included countries such as China, India, Brazil, Australia, and Japan. This is an indication of the global health impact of SSBs. Studies on the global and country-based consumption of SSBs indicated that consumption of SSBs is a global public health problem and that there is a wide variation in SSB consumption based on world region, age, ethnicity, and gender.[17],[18],[73],[74]

The impact of SSBs on human health is well documented. Several studies have associated the consumption of SSBs with obesity/overweight,[64],[75],[76],[77] diabetes mellitus and insulin resistance,[9],[78],[79] cardiovascular disorders,[80],[81],[82] hyperuricemia and gout,[83],[84] depression,[85],[86] cancer,[87],[88],[89] and dental caries.[90],[91] These wide range of adverse health effects explains why most of the published documents about SSBs focused on health outcome and methods and policies needed to decrease the consumption of SSBs. Imposing taxes was one policy which received a lot of focus in this regard, and publications on the impact of imposing more taxes on SSB have received a lot of citation. Taxing SSBs had shown to decrease national adverse effects of SSBs and to generate revenues.[58],[92] One study indicated that taxing SSBs would cut health and cost burdens of diabetes.[93] Another study suggested that taxing SSBs is an appropriate method to combat national burden of obesity.[94] Restricting SSBs in schools had also been suggested as a mechanism to combat obesity among children.[95],[96] Another suggested cost-effective and national policy to cut down SSB consumption was restricting television advertising for unhealthy foods or SSBs.[97],[98]

Our study showed that CI in publishing SSB research was increasing with time. However, it seems that this collaboration is mostly an intracountry collaboration among researchers in different institutions in the same country. However, international collaboration in publishing research on SSBs was not high. This is understandable given that consumption of SSBs is not an infectious disease that requires international collaboration to combat the spread of the infection. Despite that, consumption is a nutritional habit of global dimension and collaboration in research pertaining to health research and policies to cut down the consumption of SSBs should be encouraged. Research collaboration will not only promote health policies and increase awareness across different countries, but also will increase scientific productivity at the individual level.[99] In our study, research collaboration in SSBs was limited to country clusters in three world regions, mainly the European cluster which might be facilitated by geographic proximity.

Despite that the majority of publications on SSBs were focused on health-related issues, publications on the chemistry and manufacturing technology were also found. Measurements and methods used to quantify various components of SSB were the main chemistry topics discussed in the field of SSBs.[100],[101],[102],[103] Of particular interest is chemical analysis of potential toxic materials such as pesticides and bisphenols in SSBs.[104],[105]

There are many systematic reviews and meta-analyses on SSB.[9],[46],[64] However, no bibliometric study has been published on this topic and our current study is the first to analyze the quantity and quality of SSB publications and present the trend in a bibliometric trend using commonly utilized indicators. This study is part of the national and international efforts aimed to shed light on adverse nutritional outcomes of SSBs. Research efforts in the field of SSBs will encourage researchers in the field and will serve as a means to draw future policies in this regard. Despite all these, our study had few limitations that are inherent in such bibliometric studies.[106],[107],[108],[109],[110] There is no perfect bibliometric study and false-positive and/or false-negative results are always a possibility particularly when discussing topics with so many potential representative keywords and when using databases that do not include all peer-reviewed journals issued across the globe. However, the purpose of this study was to positively participate in the field of SSBs rather than reaching a perfect story of worldwide research productivity in SSBs.


  Conclusion Top


Our study gave a detailed descriptive quantitative and qualitative analysis of literature on SSBs in the past 16 years. Medicine-related aspects of SSB publications, particularly the adverse nutritional effects, dominated the literature on SSBs. The growth of literature on SSBs decreased during the study period, but the quality and importance of such publications remained high as witnessed by the sharp increase in the total citation and the IF of journals publishing articles on SSBs. The adverse nutritional aspects of SSBs were mainly those pertaining to obesity, diabetes mellitus, and cardiometabolic aspects. Research and results of experimental studies on SSBs need to be used to promote awareness related to health aspects of SSBs and promote health policymakers to use these data in campaigns dedicated for reduction of SSB consumption, particularly in countries with prevalent obesity, overweight, and diabetes mellitus.

Limitations

Although this article is the first of its type to present bibliometric data about SSBs, yet, it did have some limitations. It may not have focused on a specific aspect per se, but it is good in presenting a general idea about this health-related issue. This may be a beginning of a series of articles that investigate the deep aspects of this part of human health.

Availability of data and material

all data present in this article can be retrieved from Scopus using keywords listed in the methodology section.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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