From autism to obesity and beyond: mapping global trends and gaps in pediatric gut microbiota interventions—a bibliometric analysis

Introduction

Child health not only shapes immediate quality of life but also profoundly influences future life trajectories (1). Children who are physically strong, emotionally stable, and able to concentrate are more likely to gain lasting advantages in academic achievement, social relationships, and psychological wellbeing (2). However, children today face multiple challenges, including nutritional imbalances, chronic diseases, and psychological stress, highlighting the urgent need for safe, effective, and sustainable health-promotion strategies (3). Against this backdrop, the gut microbiota has emerged as a critical frontier in pediatric health research owing to its central roles in nutrient absorption, immune regulation, and neurodevelopment (4). Increasing evidence suggests that appropriate microbiota-targeted interventions may not only aid in disease management, but also modulate early cognitive function and emotional well-being through gut–brain axis interactions (5).

In recent years, gut microbiota interventions have shown substantial potential in the treatment of various pediatric diseases. For example, emerging clinical evidence suggests that probiotic supplementation and fecal microbiota transplantation may alleviate gastrointestinal symptoms and potentially modulate behavioral outcomes in children with autism spectrum disorder (ASD) (6), fecal microbiota transplantation has demonstrated high success rates in treating recurrent Clostridioides difficile infection in immunocompromised pediatric patients (7), and targeted dietary interventions have restored the gut microbial ecology and improved metabolic health in children with obesity or malnutrition (8). Probiotics have likewise been evaluated as a microbiota-targeted intervention for functional constipation in children (9). These advances not only facilitate translation from mechanistic insights into clinical applications, but also underscore the rapid growth of this research field.

However, existing studies are scattered across diverse disease types, intervention strategies, and research groups, lacking a systematic synthesis of the overall research landscape, scholarly networks, and thematic evolution (10). This fragmentation underscores the need for systematic quantitative analysis to identify research hotspots, collaboration patterns, and evidence gaps across the field (11).

Bibliometric analysis, as a quantitative approach based on large-scale literature data, has proven its value in multiple clinical domains (11,12). Bibliometric analyses of gut microbiota research in specific disease areas have been used to map publication landscapes, identify leading contributors and collaborative networks, and track thematic evolution over time (13), demonstrating that bibliometrics can objectively delineate research hotspots and trajectories while directly informing cross-institutional collaboration, clinical trial design, and policy-making (14). Similarly, bibliometric analyses of coronavirus disease 2019 (COVID-19) vaccine research revealed a surge in messenger RNA (mRNA) technology and the distribution of leading research teams, with findings incorporated into the World Health Organization (WHO) research and development (R&D) roadmap to guide global vaccine resource allocation (15). Accordingly, conducting a systematic bibliometric analysis of “pediatric disease–gut microbiota intervention” research can provide clinicians and scientists with a visual, evidence-based framework to identify high-impact achievements and emerging opportunities, thereby helping to orient future research priorities and collaboration in this field (16,17).

Against this backdrop, we conducted a bibliometric analysis to map the global landscape and research trends of “pediatric diseases–gut microbiota interventions” over the past 15 years. We analyzed publication output, geographic and institutional distribution, author collaborations, highly cited articles, and core journals, complemented by keyword clustering and co-citation mapping, to identify research hotspots, gaps, and knowledge bases. Compared with narrative reviews, this quantitative and visualized approach offers an objective overview of the field, enabling the recognition of high-impact work and emerging directions. Such evidence can help guide cross-disciplinary collaboration, resource allocation, and the prioritization of future studies, supporting a balanced research agenda spanning disease management, sub-health interventions, and developmental promotion in children. We present this article in accordance with the BIBLIO reporting checklist (available at https://tp.amegroups.com/article/view/10.21037/tp-2026-0386/rc).

Methods

Data source and search strategy

A comprehensive literature search was performed on July 6, 2025, using the Web of Science Core Collection (WoSCC) to identify publications related to gut microbiota interventions in pediatric populations. The following topic search formula was applied: (((gut microbiota[topic] OR gut microbiome[topic]) AND (child[topic] OR children[topic] OR pediatric[topic] OR infant[topic] OR adolescent[topic])) AND (intervention[topic] OR trial[topic] OR effect[topic] OR modulation[topic] OR dietary intervention[topic] OR probiotic supplementation[topic] OR synbiotics[topic] OR physical activity intervention[topic] OR antibiotic exposure[topic] OR breastfeeding intervention[topic] OR FMT therapy[topic])). Only articles and reviews published in English and indexed in the Science Citation Index Expanded (SCI-Expanded) category were included. The publication period was from January 1, 2010, to July 1, 2025. The initial search retrieved 1,955 records from WoSCC. After applying document-type filters (excluding non-article and non-review types, n=3) and language filters (excluding non-English publications, n=8), a total of 11 records were removed, yielding 1,944 records that were retained for eligibility screening. Two reviewers then independently screened titles and abstracts, with full-text review where necessary, against the predefined eligibility criteria (Section 2.2); at this stage, 29 records were excluded because the study population was not pediatric (i.e., conducted in adult or mixed adult cohorts without pediatric-specific data), yielding a final total of 1,915 publications for inclusion in the bibliometric analysis. No additional deduplication was required, as WoSCC does not return duplicate records for a single-database query. The full screening process is illustrated in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-style flow diagram (Figure S1).

Inclusion and exclusion criteria

Two reviewers independently screened the titles and abstracts of the retrieved articles. Disagreements were resolved through consensus. Studies were included if they met the following criteria: (I) the publication primarily focused on the gut microbiota or gut microbiome and its relationship with pediatric populations, including infants, children, or adolescents; (II) the study investigated intervention strategies or modulatory effects targeting gut microbiota, such as dietary interventions, probiotic supplementation, synbiotics, physical activity interventions, antibiotic exposure, breastfeeding interventions, or fecal microbiota transplantation (FMT); (III) the document was published as an original research article or review article in English; and (IV) publications indexed in the SCI-Expanded category of WoSCC. Exclusion criteria were as follows: (I) publications with only superficial mention of gut microbiota or pediatric interventions; (II) non-article types such as meeting abstracts, editorials, commentaries, or book chapters; (III) non-English publications; and (IV) duplicate records identified during the screening process.

Data extraction and processing

Metadata of the included publications, including title, authors, affiliations, year of publication, document type, journal name, citation counts, and subject categories, were exported from WoSCC in plain text and tab-delimited formats. The data were organized and cleaned using Microsoft Excel 2021. The cleaning process included the removal of duplicates, standardization of author and institutional names, and verification of document types. Publications were categorized into original research articles, review articles, and others (such as early access articles or corrections). The publication data were independently verified by two reviewers. This structured dataset served as the basis for subsequent bibliometric analysis.

Bibliometric tools and visualization

Bibliometric analyses were performed using VOSviewer (v1.6.19), CiteSpace (v6.2.4), and R using the Bibliometrix package (v4.0.0). The analysis covered (I) annual publication and citation trends, (II) country and institutional contributions, (III) author collaboration networks, (IV) journal and subject category distributions, (V) keyword co-occurrence, bursts, and temporal dynamics, and (VI) reference co-citation and thematic evolution patterns. In VOSviewer, keyword co-occurrence networks were constructed using a minimum keyword frequency threshold of 5 occurrences; author collaboration networks required a minimum of 3 publications per author. In CiteSpace, the time slice was set to 1 year per slice covering 2010–2025, with the top 50 cited references selected per slice for co-citation clustering; keyword burst detection used the default γ = 0.5 and minimum duration of 2 years. Thematic mapping in bibliometrix was based on co-word analysis using the association strength normalization. All visualizations were exported in high-resolution Tagged Image File Format (TIFF) or PDF format for publication quality.

Statistical analysis

This bibliometric study was descriptive in nature, and no inferential hypothesis testing was performed. Counts, percentages, and cumulative frequencies were calculated in Microsoft Excel 2021 and the R package bibliometrix (v4.0.0). Annual publication counts and average citations per publication were computed as descriptive summary statistics. Country-level output was quantified by corresponding-author counts and stratified into single country publications (SCP) and multiple country publications (MCP), with the MCP ratio expressed as a percentage. Keyword co-occurrence networks were constructed in VOSviewer (v1.6.19) using association strength normalization, with a minimum occurrence threshold of 5; author collaboration networks required a minimum of 3 publications per author. In CiteSpace (v6.2.4), co-citation clustering used 1-year time slices covering 2010–2025 with the top 50 cited references per slice, and keyword burst detection used γ=0.5 with a minimum burst duration of 2 years. Thematic maps were generated in bibliometrix using co-word analysis with association strength normalization. All values are reported as absolute counts with percentages where applicable.

Data availability and limitations

All data were retrieved from the Web of Science Core Collection (WoSCC). Publications not indexed in this database, including regional journals, preprints, or non-English literature, may have been excluded, potentially introducing a selection bias.

Results

According to the predefined retrieval strategy, 1,915 publications related to pediatric gut microbiota interventions were identified from the Web of Science Core Collection database, spanning the period from 2010 to 2025. These articles involved 12,308 authors and were published in 546 journals, with a cumulative total of 39,956 cited references and 3,510 unique keywords. Notably, 27.12% of the publications resulted from multi-country (international) collaborations, indicating a moderate level of cross-regional cooperation in this field. Of the 1,915 included publications, 1,260 (65.8%) were original research articles and 655 (34.2%) were review articles; among the reviews, only 2 were systematic reviews, with no meta-analyses or scoping reviews identified, the remainder being narrative or general reviews.

Annual publication trends and author–institution–journal relationships

Figure 1A illustrates annual publication and citation trends from 2010 to 2025. The number of publications has increased steadily over time, with a marked surge after 2018 and peaking in 2024. By contrast, the average number of citations per article fluctuated, with the highest level observed in 2014, followed by a progressive decline in more recent years, consistent with citation time-lag. These patterns suggest sustained growth in research output and academic interest, although recent publications have not yet accumulated substantial citations due to time lag. Figure 1B shows the flow between prolific authors (AU), their affiliated institutions (AU_UN), and the journals (SO) in which they published. The visualization highlights a relatively structured publication landscape, where leading authors tend to be clustered within a few key institutions and often publish in a defined set of journals, indicating the presence of established academic trajectories and preferred dissemination outlets in the field. However, vertical stratification also implies a degree of institutional concentration, with certain universities acting as primary hubs linking author teams and targeted journals.

Figure 1 Annual publication trends and author-institution-journal collaboration network in pediatric gut microbiota intervention research [2010–2025]. (A) Bar chart displaying annual number of publications (blue bars) and average citations per article (green line). (B) Sankey diagram illustrating collaborative relationships among top contributing authors (AU), affiliated institutions (AU_UN), and journals (SO). AU, authors; AvgCitations, average citations per publication; SO, sources (journals); UN, universities (affiliated institutions).

Journal distribution and temporal trends

The distribution of publication venues revealed a strong preference for journals focused on nutrition, microbiology, and pediatric health (Figure 2A). Nutrients ranked first, with 123 publications, followed by Scientific Reports, Gut Microbes, and Frontiers in Microbiology, each publishing over 50 articles. This indicates that the field is primarily situated at the intersection of dietary science and microbial research, with growing attention from multidisciplinary journals. The longitudinal trends of the top five journals (Figure 2B) showed that Nutrients exhibited a marked and consistent rise in publication output after 2018, becoming the leading outlet in recent years. Other journals, such as Scientific Reports, Gut Microbes, and Microorganisms, also showed steady increases after 2020. The acceleration in publication activity across multiple journals suggests an expanding interest and diversification of research themes within the pediatric gut microbiota intervention domain.

Figure 2 Distribution and temporal trends of top journals publishing pediatric gut microbiota intervention research [2010–2025]. (A) Bar chart showing number of publications in the top 10 most productive journals. (B) Line chart displaying annual publication trends of the top five journals.

Geographic distribution and author productivity

The global landscape of pediatric gut microbiota intervention research demonstrated notable geographic disparities (Figure 3A). China and the United States dominated this field as the two largest national contributors, as shown in the global distribution map (Figure 3A); together with other leading European and North American countries, they accounted for the majority of published studies, highlighting the concentration of scholarly activity in a limited number of regions. Notably, while Europe, North America, and East Asia emerged as leading contributors, Africa and South America remained underrepresented, suggesting potential gaps in global research equity. To further assess individual research outputs, the top 10 most productive authors were ranked by publication count (Figure 3B). Knol Jan led with 21 publications, followed closely by Ahmed Tahmeed (18), Lacroix Christoph E (17), and Turvey Stuart E (17). Most of these authors are affiliated with institutions in Europe and North America. A temporal analysis of their publication activity revealed that most high-output researchers became active after 2020, with a marked increase in output between 2021 and 2024 (Figure 3C). This pattern aligns with the overall acceleration of research in the field and suggests the recent emergence of influential contributors. However, sustained output remains limited to a small number of individuals, and no dominant author clusters or long-standing collaborative teams have yet been established.

Figure 3 Geographic distribution and author productivity in pediatric gut microbiota intervention research [2010–2025]. (A) World map illustrating global publication output. (B) Bar chart ranking top 10 most productive authors. (C) Timeline of annual publication activity for top authors.

Countries and author cooperation

We analyzed international and author-level cooperation networks from 2010 to 2025 to examine collaborative patterns in pediatric gut microbiota intervention research. As shown in Figure 4A, the global map highlights that China and the United States dominate publication volumes and serve as central nodes in international collaborations. Numerous cooperative links exist between North America, East Asia, and Europe, while contributions from regions such as Africa and South America remain sparse. This uneven distribution suggests that global research efforts are concentrated within a few countries and lack broader geographic inclusiveness. Figure 4B further illustrates that although China produced the most publications by corresponding-author count (n=342), only 14.3% of these involved multi-country collaboration [multiple country publications (MCP)], indicating a relatively high proportion of single-country (domestic) publications [single country publications (SCP)]; here, national publication counts reflect each article’s corresponding-author count. By contrast, countries such as Switzerland, Ireland, and Germany demonstrated a higher MCP ratio, suggesting stronger international engagement despite lower publication volumes. These differences underscore varying degrees of openness to cross-border cooperation across countries. At the author level, the co-authorship network (Figure 4C) revealed multiple discrete collaboration clusters. For instance, Stuart E leads a highly interconnected group in North America, while Knol Jan and Isolauri Erika form a prominent European cluster. Ahmed Tahmeed and Roberto Berni Canani anchor distinct research teams with limited external links. Overall, while some author groups exhibit strong internal collaboration, inter-group connections remain weak, reflecting limited cross-regional or interdisciplinary integration in this field.

Figure 4 International and author-level collaboration patterns in pediatric gut microbiota intervention research [2010–2025]. (A) World map showing international collaboration links. (B) Bar chart depicting SCP and MCP proportions among the top 20 countries. (C) Co-authorship network (VOSviewer). MCP, multiple country publications; SCP, single country publications.

Citation analysis

A total of 1,915 publications were retrieved between 2010 and 2025, with a field-wide mean of 1.872 citations per document (total citations recorded in the Web of Science Core Collection). This modest overall value is driven largely by the high proportion of recent publications [2021–2025] that have had limited time to accumulate citations, rather than by uniformly low impact across the field. However, a subset of studies has achieved substantial visibility. The most cited article, published in Cell Host & Microbe [2014], was cited 1,462 times, highlighting its foundational role. Other frequently cited studies were published in Nature (577 citations) and Nutrients (555 citations), focusing on microbial immaturity and diet-microbiota interactions, respectively. In terms of journal quality, the highest impact factor among the included publications reached 88.5 (Lancet), followed by 78.5 (New England Journal of Medicine) and 66.8 (Nature Reviews Cancer) (Tables 1,2). While several of these high-impact articles had lower citation counts, this may be attributable to their recent publication dates (e.g., 2023–2024). Overall, the landscape comprises both widely cited landmark studies and newly emerging high-profile work, reflecting a growing but uneven research impact in this area.

Keyword analysis: research hotspots evolve from disease association to intervention and developmental themes

To map the thematic landscape of pediatric gut microbiota intervention research, we conducted comprehensive keyword analysis. As shown in Figure 5A,5B, core keywords such as “gut microbiota”, “microbiome”, “microbiota”, “probiotics”, “gut microbiome”, “children”, “infant”, and “obesity” were the most frequent, reflecting persistent attention to host-microbiota interactions and probiotic interventions in early life. Notably, “dysbiosis” and “antibiotics” also ranked among the ten most frequent terms, indicating sustained interest in microbial disturbance, while disease-focused terms such as “obesity” and “autism spectrum disorder” remained prominent across the broader keyword landscape. Temporal trend analysis (Figure 5C) revealed that while the usage of dominant terms peaked between 2021 and 2023, newer terms, such as “human milk oligosaccharides”, “short-chain fatty acids”, and “infant formula” have recently emerged, highlighting an increasing focus on nutritional modulation and early-life microbial programming. Thematic clustering (Figure 5D) suggested a division between mechanism-intervention keywords [e.g., probiotics, prebiotics, short-chain fatty acids (SCFAs)] and disease-related terms (e.g., autism, eczema, allergy), reflecting dual research streams that approach the pediatric gut microbiota from both therapeutic and pathological perspectives. Furthermore, the Sankey analysis (Figure 5E) illustrated a thematic transition from earlier concerns such as “antibiotic resistance”, “malnutrition”, and “celiac disease” toward recent emphases on “obesity”, “epidemiology”, “early childhood”, and “dietary interventions”. This shift suggests a gradual broadening of the research agenda from disease identification to preventive strategies and developmental outcomes. Collectively, keyword evolution reveals a trajectory from disease-centric exploration to a more integrative focus encompassing dietary, microbial, and developmental determinants. However, the lack of high-frequency keywords related to long-term outcomes, behavioral traits, or socioenvironmental factors implies that holistic and longitudinal perspectives remain underrepresented in the current literature.

Figure 5 Keyword analysis and thematic evolution in pediatric gut microbiota intervention research. (A) Word cloud of most frequent keywords. (B) Bar chart of top 10 high-frequency keywords. (C) Trend analysis of emerging keywords [2021–2025]. (D) Thematic mapping of keyword co-occurrence. (E) Sankey diagram of keyword theme evolution (2010–2022 vs. 2023–2025).

To directly compare the temporal trajectories of the principal intervention strategies, we tracked the cumulative annual occurrence frequency of the keywords associated with each intervention type across 2013–2025 (Figure 6). Traditional microbial supplementation (probiotics and prebiotics) was by far the most prominent and fastest-growing category, rising from a single occurrence in 2013 to 280 cumulative occurrences by 2025, with a marked acceleration after 2020. Precision/personalized nutrition (human milk oligosaccharides, infant formula, and dietary interventions) and fecal microbiota transplantation (FMT) represented substantially smaller but steadily expanding streams, reaching 44 and 23 cumulative occurrences, respectively, by 2025, with their steepest growth occurring in the most recent period [2022–2025]. This indicates that, although probiotic- and prebiotic-based approaches remain the dominant and most empirically active intervention paradigm in pediatric gut microbiota research, precision-nutrition and FMT strategies are gaining momentum as later-emerging entrants.

Figure 6 Temporal trajectories of the major pediatric gut microbiota intervention types [2013–2025]. Cumulative keyword-occurrence frequencies are shown for traditional microbial supplementation (probiotics, prebiotics), precision/personalized nutrition (human milk oligosaccharides, infant formula, dietary interventions), and FMT, derived from the bibliometrix words-frequency-over-time analysis of the cleaned dataset. As FMT is frequently discussed in text without being indexed as an author keyword, its trajectory likely represents a conservative lower bound. FMT, fecal microbiota transplantation.

Synthesis of findings and research gaps

Taken together, the findings from this bibliometric analysis reveal a field that has grown rapidly but unevenly. Four principal research gaps emerge from the synthesis of quantitative indicators. First, a geographic gap: despite global relevance, the majority of research originates from China and the United States, leaving regions with the highest burden of microbiota-relevant pediatric conditions (Sub-Saharan Africa, South Asia, Latin America) profoundly underrepresented. Second, a collaboration gap: with only 27.12% of publications involving multi-country (international) collaboration, the field lacks the cross-institutional networks needed to generate large-scale, generalizable evidence. Third, a thematic gap: current research is heavily disease-centered (ASD, obesity, malnutrition), while developmental and behavioral endpoints in otherwise healthy children—including cognitive development, emotional regulation, and executive function—remain absent from the bibliometric landscape. Fourth, a methodological gap: single-platform analyses dominate the literature, while multi-omics integration and personalized nutrition approaches, though emerging, have not yet been systematically applied across diverse pediatric populations. These gaps collectively point toward a research agenda centered on geographic diversification, multinational collaboration, expanded outcome measurement, and integrated analytical frameworks as the priority directions for the next phase of the field.

Discussion

This bibliometric study systematically maps the global research landscape of pediatric gut microbiota interventions from 2010 to 2025, revealing a field characterized by rapid expansion, geographic concentration, and thematic imbalance. The findings offer a structured overview of where the field has been productive, where it remains limited, and where the most critical opportunities for development lie.

Geographic concentration and the need for broader international collaboration

Our analysis demonstrates that China and the United States are the two dominant national contributors in this field, forming a characteristic dual-core dominance that reflects patterns observed across other rapidly expanding biomedical research domains. Beyond these two leading nations, contributions from most regions—particularly low- and middle-income countries across Africa, South America, and Southeast Asia—remain minimal, despite the high burden of pediatric malnutrition, infectious disease, and microbiota-relevant conditions in these settings (18). This geographic imbalance not only reflects unequal distribution of research infrastructure and funding, but also risks producing a body of evidence biased toward the dietary patterns, microbial compositions, and healthcare contexts of East Asian and Western populations, thus reducing its generalizability to global pediatric populations (19,20).

International collaboration patterns further underscore this concentration. Although China generated the highest absolute publication volume by corresponding-author count (n=342), only 14.3% of these publications involved multi-country collaboration (MCP), compared with substantially higher MCP rates observed in smaller but more internationally engaged countries such as Switzerland, Ireland, and Germany. This suggests that high-volume countries may be operating predominantly within domestic research ecosystems, limiting the methodological cross-pollination and contextual diversity that multinational studies provide (21,22). Prior research has demonstrated that multinational collaboration offers advantages beyond enlarged sample sizes, including resource pooling, methodological standardization, and perspective integration (23). Successful multinational frameworks—such as the European Union (EU)-funded Lifebrain project integrating longitudinal data from multiple countries to elucidate microbiota-nutrition-cognition mechanisms (24), the NuAge-Microbiome study comparing gut microbial profiles across dietary contexts (25), and the MetaCardis consortium building cross-country cardiometabolic cohorts to validate gut-brain axis mechanisms in diverse populations (26,27)—offer instructive models for how structured international collaboration can accelerate both mechanistic discovery and clinical translation (28). Future pediatric microbiota intervention research, particularly studies targeting children in diverse dietary and environmental settings, should leverage such cooperative frameworks to enable a shift from descriptive observation to structured interventional design. From a translational perspective, clinicians and trialists designing pediatric gut microbiota interventions should actively seek partnerships with institutions in Africa, South America, and Southeast Asia—regions where the burden of microbiota-relevant pediatric conditions is highest yet research representation is lowest—to ensure that intervention findings are actionable across diverse healthcare settings and not confined to high-income country contexts (29).

Thematic landscape: progress in disease management, gaps in developmental outcomes

Keyword co-occurrence analysis and citation patterns reveal that current research is heavily anchored in three disease areas: ASD, childhood obesity, and nutritional imbalances. These represent the field’s most mature and translationally active clusters. In the context of ASD, evidence from both mechanistic and interventional studies supports a role for gut dysbiosis in the modulation of behavioral and gastrointestinal symptoms, and microbiota-targeted strategies including probiotic supplementation and fecal microbiota transplantation have shown promise in controlled settings (30,31). For childhood obesity and malnutrition, targeted dietary interventions have demonstrated measurable effects on microbial ecology and metabolic parameters, with several landmark studies influencing clinical nutrition guidelines (32). The concentration of high-frequency keywords and high-impact publications around these three conditions—reflected in Figure 5 and Table 1—indicates that disease-centered microbiota research has progressed meaningfully from mechanistic discovery toward early clinical translation, representing a legitimate and important research priority (33).

However, a substantial proportion of clinically and developmentally important outcomes remains underrepresented in the bibliometric landscape. Specifically, terms related to learning ability, emotional regulation, executive function, and behavioral development are largely absent from keyword co-occurrence networks and are not represented among high-impact publications (34,35). A recent global bibliometric analysis has specifically mapped the intersection of gut microbiota research and academic and developmental traits in children (36). This structural gap is concerning given that early cognitive and behavioral traits are robust predictors of long-term academic achievement, social competence, and mental health (37). For instance, longitudinal research has demonstrated that preschool executive function explains a meaningful proportion of the variance in academic and social outcomes observed a decade later (38), and that early emotional regulation capacity significantly predicts the risk of anxiety and depression in adolescence (39). These findings underscore the long-term impact of early behavioral traits and suggest that microbiota intervention research should extend beyond disease correction toward supporting cognitive potential and behavioral development from an early stage (40,41).

The absence of developmental and educational outcomes from the current keyword landscape likely reflects a structural bias in how the field has evolved: most intervention frameworks originate from top-down extensions of disease models, rather than bottom-up perspectives centered on optimizing behavior and developmental potential in otherwise healthy children (42,43). Bridging this divide represents one of the most important frontier opportunities in pediatric microbiota research. Incorporating developmental and behavioral endpoints—alongside established disease-focused outcomes—into future interventional trials would substantially enhance the translational scope and societal impact of this field. Accordingly, future interventional trials and prospective cohort studies enrolling children with ASD, obesity, or nutritional disorders should incorporate validated instruments for cognitive function and emotional regulation alongside standard disease metrics; embedding such developmental endpoints in study designs would generate the longitudinal evidence needed to justify and adequately power subsequent microbiota intervention trials targeting developmental outcomes.

Emerging themes and future directions

Keyword burst analysis identifies three convergent themes that are likely to define the field’s next developmental phase. First, personalized nutrition—particularly the roles of human milk oligosaccharides, SCFAs, and early-life dietary patterns in shaping microbial communities—is emerging as a major area of investigation, reflecting a shift from generic dietary advice to precision microbiota modulation (44,45). Second, multi-omics integration (combining metagenomics, metabolomics, and transcriptomics) is increasingly applied to characterize host-microbiota interactions with mechanistic specificity that single-platform analyses cannot achieve. Third, microbiota-brain-behavior linkages continue to attract growing research attention, supported by expanding evidence from animal models and emerging human studies (44,45).

These three directions are not independent: understanding how specific nutritional inputs shape microbial communities that in turn influence neurodevelopmental trajectories will require integrated multi-omics platforms applied across culturally and demographically diverse populations. The current low rate of multi-country (international) collaboration (27.12%) suggests that the institutional and methodological infrastructure for such integration has not yet been established at the required scale. Investing in shared data platforms, standardized sampling protocols, and harmonized outcome measurement will be critical for realizing the potential of these emerging approaches. From a research-agenda perspective, these converging trends carry a concrete implication: future trials and systematic reviews should rigorously evaluate whether individualized microbiota profiling, rather than reliance on population-level averages, improves outcomes in pediatric subgroups at risk for neurodevelopmental, metabolic, or immune dysregulation, and funding bodies should prioritize the multi-omics and longitudinal infrastructure required before such precision approaches can be incorporated into evidence-based clinical guidelines.

Limitations

This study has several limitations inherent to bibliometric methodology. First, data were retrieved exclusively from the Web of Science Core Collection, potentially excluding relevant publications indexed in PubMed, Scopus, China National Knowledge Infrastructure (CNKI), or regional databases, which may introduce geographic and linguistic bias into the findings. Second, the English-language restriction may have systematically underrepresented research from non-English-speaking countries, contributing to the observed geographic skew. Because these database and language restrictions would, on their own, tend to over-represent English-language output from North America, Europe, and East Asia, the pronounced geographic concentration reported here—and the apparent underrepresentation of regions such as Africa, South America, and South Asia—may be partly an artifact of the search methodology rather than a fully accurate reflection of true global research activity. This finding should therefore be interpreted as a methodologically conditioned pattern rather than definitive evidence of a research gap, and confirmation would require multi-database, multilingual analyses. Third, citation counts are subject to time-lag effects, particularly for publications from 2022 to 2025, which have had insufficient time to accumulate citations and may thus appear to underperform relative to older studies. Fourth, while keyword co-occurrence and co-citation analyses identify prominent themes and influential studies, they do not evaluate the methodological quality of individual publications; conclusions about field structure should therefore be interpreted as structural and epidemiological observations rather than evidence-based clinical recommendations. Notwithstanding these limitations, the breadth of the dataset (1,915 publications across 15 years) and the systematic application of multiple complementary bibliometric methods provide a robust and reproducible overview of the global research landscape. Clinicians and guideline developers should treat the findings presented here as a research priority map rather than a clinical directive: the identified hotspots and gaps should be used to inform the design of future primary studies and systematic reviews, which in turn will provide the intervention-level evidence needed to shape pediatric clinical practice.

Conclusions

This bibliometric analysis of 1,915 publications spanning 2010 to 2025 provides the first comprehensive, quantitative map of the global research landscape on pediatric gut microbiota interventions across disease domains, directly addressing the objectives stated in the Introduction. Regarding publication output and trends: global research activity has expanded markedly since 2010, with a pronounced acceleration after 2018, confirming that the field has transitioned from emergent to rapidly maturing. Regarding geographic and institutional distribution: China and the United States dominate output, while Africa, South America, and Southeast Asia remain severely underrepresented. Regarding collaboration networks: multi-country (international) collaboration constitutes only 27.12% of publications—a structural bottleneck constraining methodological diversity and ecological representativeness. Regarding thematic evolution: research hotspots have concentrated around ASD, childhood obesity, and nutritional disorders, with an emerging but incomplete transition toward preventive and developmental perspectives. Together, these findings clarify the global research structure and thematic trends that were previously unclear, while also revealing the gaps that require priority attention.

Research attention has clustered around ASD, childhood obesity, and nutritional disorders, where mechanistic understanding and early translational evidence are most mature. However, a substantial gap remains in studies targeting cognitive development, emotional regulation, and behavioral outcomes in otherwise healthy children—endpoints that are directly relevant to long-term academic and social functioning and that represent a frontier of considerable clinical and public health importance. Keyword evolution confirms a gradual but incomplete transition from disease identification toward preventive and developmental perspectives.

These findings carry direct implications for the future research agenda. Future intervention trials and systematic reviews should broaden outcome measures beyond symptom relief to include standardized developmental and behavioral endpoints. Funding bodies and research consortia should prioritize multinational collaboration frameworks—particularly those incorporating low- and middle-income country populations—to improve generalizability and reduce sampling bias. The three emerging themes identified—personalized nutrition, microbiota-brain-behavior linkages, and multi-omics integration—represent the most promising avenues for future high-impact investigation. Sustained investment in shared data infrastructure and harmonized outcome measurement will be essential to translate this rapidly expanding evidence base into actionable clinical guidance for pediatric populations worldwide.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the BIBLIO reporting checklist. Available at https://tp.amegroups.com/article/view/10.21037/tp-2026-0386/rc

Peer Review File: Available at https://tp.amegroups.com/article/view/10.21037/tp-2026-0386/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-2026-0386/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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