Espen Kolstad Heen

Doctoral Research Fellow - Department of Community Medicine and Global Health

Norwegian version of this page

Email e.k.heen@medisin.uio.no

Mobile phone +4799736353

Room 276

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Visiting address Fredrik Holst Hus Ullevål

Postal address Postboks 1130 Blindern 0318 Oslo

Other affiliations Faculty of Medicine (Student)

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Academic interests

Iodine nutrition. Methodological issues in the analysis of micronutrients at individual and population level, Fluid intake and measurement of hydration, Neonatal morbidity and mortality in low-income countries. Health systems research. Stress-induced diseases. Use of AI in medical research.

Courses taught

Master in International Health - introductory courses - University of Oslo
Various modules for medical students 1-4th year - community medicine and epidemiology
Various courses for master in advanced clinical community nursing - Østfold University College
Basic epidemiology and research methodology - University of Hargeisa
Neonatology for medical and midwifery students - University of Hargeisa

Background

Physical Training instructor in the Norwegian Navy (1992) MD (2001), DTMH Liverpool School of Tropical Medicine (2009) Mphil International Health Helsam UiO (2012)

Clinical experience: Family medicine, Internal Medicine/Geriatrics, Pediatrics, Neonatology and Psychiatry.

Teaching: Epidemiology, Micronutrition, Medical ethics, Neonatology, International Health, Spirituality in medicine, chronic lung and cardiovascular diseases.

Health Development Project CEO, developing curriculums and monitoring systems for Medical education (medical and nursing students) in Eastern Africa/Horn of Africa and Norway

Partners

University of Hargeisa, medical faculty

CMF Kenya

Queen Mary University of London, Wolfson Institute of Population Health

University Children’s Hospital Zurich, Division of Gastroenterology and Nutrition, Zürich, Switzerland

Oslo Metropolitan University, Faculty of Health Sciences, Department of Community Nutrition

CICERO Center for International Climate Research, a research group on climate change and health

Tags: Global health, mother and child, Nutritional epidemiology, water and hydration

Henjum, Sigrun; Groufh-Jacobsen, Synne; Aakre, Inger; Gjengedal, Elin Lovise Folven; Langfjord, Mina Marthinsen & Heen, Espen Kolstad [Show all 8 contributors for this article] (2023). Thyroid function and urinary concentrations of iodine, selenium, and arsenic in vegans, lacto-ovo vegetarians and pescatarians. European Journal of Nutrition. ISSN 1436-6207. 62, p. 3329–3338. doi: 10.1007/s00394-023-03218-5. Full text in Research Archive Show summary
Purpose Populations following a plant-based diet may be at particular risk of thyroid dysfunction due to low iodine and selenium intakes. The main purpose was to assess thyroid function and urinary concentration of iodine, selenium, and arsenic, in subjects following a vegan, lacto-ovo vegetarian, or pescatarian diet. Methods In Norway, a country without mandatory dietary iodine fortification, 205 adults, following vegan (n = 115), lacto-ovo vegetarian (n = 55) and pescatarian diet (n = 35) were included. Thyroglobulin (Tg), thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), and serum anti-TPO (S-anti-TPO) were measured in a venous blood sample and concentrations of iodine (UIC), creatinine (UCC), selenium, and arsenic were measured from single spot urine samples. Results Subclinical hypothyroidism (TSH > 4.0 mU/L) was observed in 3% of subjects. The overall median (p25, p75) Tg was 17 (9, 30) µg/L and vegans had higher Tg compared to pescatarians. Vegans not consuming iodine-containing supplements (n = 43) had higher Tg, than supplement users (n = 72), 27 (11, 44) vs. 16 (8, 25) µg/L and higher fT4, 16 (15, 17) vs. 15 (14, 17) pmol/L, respectively. The overall median UIC was 57 (28, 130) µg/L, all dietary groups had median UIC below WHO thresholds. Median urinary selenium and arsenic concentration was 13 (6, 22) and 3 (2, 8) µg/L, respectively. Conclusion The prevalence of subclinical hypothyroidism was low and fT4 and fT3 were within the normal range for all dietary groups. Vegans had significantly increased Tg compared to pescatarians.
Utheim, Mari Nythun; Isaakidis, Petros; Van den Bergh, Rafael; Géraud, Bantas Bata Ghislain; Mabvouna, Rodrigue Biguioh & Omsland, Tone Kristin [Show all 8 contributors for this article] (2023). Provider-initiated HIV testing uptake and socio-economic status among women in a conflict zone in the Central African Republic: a mixed-methods cross-sectional study. Conflict and Health. ISSN 1752-1505. 17(1). doi: 10.1186/s13031-023-00505-0.
Heen, Espen Kolstad; Størdal, Ketil; Abdi, Abdirashid; Walmann, Frøydis & Lundeby, Karen Marie (2022). Facility-based care of small and sick newborns: experiences with establishing a neonatal special care unit in Somaliland. Journal of Global Health Reports (JoGHR). ISSN 2399-1623. 6. doi: 10.29392/001c.33619. Full text in Research Archive
Heen, Espen Kolstad; Romøren, Maria; Yassin, Amal A & Madar, Ahmed Ali (2021). Household Water is the Main Source of Iodine Consumption Among Women in Hargeisa, Somaliland: A Cross-Sectional Study. Journal of Nutrition. ISSN 0022-3166. doi: 10.1093/jn/nxab377. Full text in Research Archive Show summary
Background: Iodine status surveys of women in Somaliland present widely conflicting results. Previous research indicates elevated concentrations of iodine (IQR 18-72 µg/L) in groundwater used for drinking and cooking, but the relationship with iodine intake is not characterized well. Objective: We aimed to investigate the contribution of household water iodine concentration (WIC), breastfeeding, total fluid intake, hydration levels, and urine volume on urinary iodine concentration and excretion (UIC, UIE) during 24 hours, and to define iodine status from iodine intake estimates and median UIC, normalized to a mean urine volume of 1.38L/day (hydration-adjusted). Methods: The study sample comprised 118 nonpregnant, healthy women aged 15-69. All resided in Hargeisa; 27 breastfeeding. Data collection consisted of a 24-hour (24-h) urine collection, a 24-h fluid intake diary, a beverage frequency questionnaire, and a structured recall interview. We measured UIC and WIC in all urine and in 49 household-water samples using the Sandell-Kolthoff reaction. Results: WIC ranged between 3 and 188 μg/L, with significant median differences across the water sources and city districts (P
Heen, Espen Kolstad; Madar, Ahmed Ali; Yassin, Amal A & Romøren, Maria (2021). Estimates of fluid intake, urine output and hydration-levels in women from Somaliland: a cross-sectional study. Journal of Nutritional Science (JNS). ISSN 2048-6790. doi: 10.1017/jns.2021.54. Full text in Research Archive Show summary
The study objective was to measure fluid intake and associations with background characteristics and hydration biomarkers in healthy, free-living, non-pregnant women aged 15–69 years from Hargeisa city. We also wanted to estimate the proportion of euhydrated participants and corresponding biomarker cut-off values. Data from 136 women, collected through diaries and questionnaires, 24h urine samples and anthropometric measurements, were obtained with a cross-sectional, purposeful sampling from fifty-two school and health clusters, representing approximately 2250 women. The mean (95 % CI) 24 h total fluid intake (TFI) for all women was 2⋅04 (1⋅88, 2⋅20) litres. In multivariate regression with weight, age, parity and a chronic health problem, only weight remained a predictor (P 0.034, B 0.0156 (l/kg)). Pure water, Somali tea and juice from powder and syrup represented 49⋅3, 24⋅6 and 11⋅7 % of TFI throughout the year, respectively. Mean (95 % CI) 24 h urine volume (Uvol) was 1⋅28 (1⋅17, 1⋅39) litres. TFI correlated strongly with 24 h urine units (r 0.67) and Uvol (r 0.59). Approximately 40 % of the women showed inadequate hydration, using a threshold of urine specific gravity (Usg) of 1⋅013 and urine colour (Ucol) of 4. Five percent had Usg > 1⋅020 and concomitant Ucol > 6, indicating dehydration. TFI lower cut-offs for euhydrated, non-breast-feeding women were 1⋅77 litres and for breast-feeding, 2⋅13 litres. Euhydration cut-off for Uvol was 0⋅95 litre, equalling 9⋅2 urine units. With the knowledge of adverse health effects of habitual hypohydration, Somaliland women should be encouraged to a higher fluid intake.
Madar, Ahmed Ali; Heen, Espen Kolstad; Hopstock, Laila Arnesdatter; Carlsen, Monica Hauger & Meyer, Haakon E (2020). Iodine intake in Norwegian women and men: The population-based Tromsø Study 2015–2016. Nutrients. ISSN 2072-6643. 12(11), p. 1–13. doi: 10.3390/nu12113246. Full text in Research Archive
Heen, Espen Kolstad & Madar, Ahmed Ali (2020). Bottled Water from National Manufacturers in Somaliland: Water Quality and Health Implications. ScienceOpen. ISSN 2199-1006. doi: 10.14293/S2199-1006.1.SOR-.PPRWQPU.v1.
Lundeby, Karen Marie; Heen, Espen Kolstad; Mosa, Mohammed; Abdi, Abdirashid & Størdal, Ketil (2020). Neonatal morbidity and mortality in Hargeisa, Somaliland: An observational, hospital based study. Pan African Medical Journal. ISSN 1937-8688. 37(3). doi: 10.11604/pamj.2020.37.3.24741. Full text in Research Archive
Madar, Ahmed Ali; Meltzer, Helle Margrete; Heen, Espen K & Meyer, Haakon E (2018). Iodine Status among Somali Immigrants in Norway. Nutrients. ISSN 2072-6643. 10(3). doi: 10.3390/nu10030305. Full text in Research Archive

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Nickelsen, Trine & Heen, Espen Kolstad (2023). Utvikler metode for å sikre optimalt jod-inntak i verden. Apollon : Forskningsmagasin for Universitetet i Oslo. ISSN 0803-6926.
Heen, Espen Kolstad; Størdal, Ketil; Wachira, John; Heen, Ingjerd & Lundeby, Karen Marie (2023). Do we need a new global policy for ending preventable perinatal deaths in fragile low-income countries? Journal of Global Health. ISSN 2047-2978. 13. doi: 10.7189/jogh.13.03008.
Heen, Espen Kolstad; Størdal, Ketil; Wachira, John; Heen, Ingjerd & Lundeby, Karen Marie (2022). Do we need a new global policy for ending preventable perinatal deaths in fragile low-income countries? Journal of Global Health. ISSN 2047-2978. 12. doi: 10.7189/jogh.12.03020. Full text in Research Archive
Engelsen, Thea Cecilie & Heen, Espen Kolstad (2022). Fortsatt dør millioner av spedbarn i sør. Forskere foreslår nye grep for pleie av nyfødte. Forskning.no. ISSN 1891-635X.
Nordland, Ester & Heen, Espen Kolstad (2022). Slik får man ned barnedødeligheten: – Tenk mindre lokalt og mer regionalt. Bistandsaktuelt. ISSN 1501-0201.
Heen, Espen Kolstad & Engelsen, Thea Cecilie (2022). We need to rethink the methodology of assessing and supplementing iodine to large population groups. sciencenorway.no.

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Published Feb. 27, 2020 10:19 AM - Last modified Sep. 6, 2023 12:47 PM

Projects

PhD Project

Systematic and random errors in the WHO methodology of median urinary iodine concentration when used as a biomarker of long-term iodine intake in a population

Abstract:

Since before the millennium, the WHO has recommended all nations to monitor long-term iodine intake in their population at regular intervals. The advised methodology includes random sampling of at least 500 individuals in defined subgroups and characterization of their iodine status by the median urinary iodine concentration (mUIC) value. The methodology builds on insights from iodine physiology, nutritional epidemiology, biostatistics and public health intervention strategies. Yet, the risk of misclassification of a population’s iodine status has never been systematically assessed. This project’s goal is to mathematically model the 95 % uncertainty interval (the sum of estimated bias and statistical random error) of the corresponding physiologically long-term iodine intake at a given mUIC and hydration-status predictor value. We expect the project to contribute to more valid population iodine assessments and improved cost-benefit iodine interventions in the global arena in the near future, contributing evidence to the revision of the WHO iodine guideline within 2025.

The project has five work packages, four collecting baseline data for the final simulation study:

WP1) Distribution and predictors of mean/median 24-hour urine volume and urine creatinine concentration (UCC) in general populations, a global systematic review and meta-analysis. (We expect WP1 to have relevance for the wider field of assessment methodology in recovery biomarkers from urine).

WP2) Analysis of coefficient of variation and bias in UIC laboratory values based on the CDC EQUIP quality control data.

WP3) Estimation of the effect of post-sampling, pre-analytic variability on UIC accuracy and precision by the Sandel-Kolthoff reaction.

WP4) Correlation between mUIC and gold standard estimates of long-term iodine intake distributions below EAR across populations.

WP5) Final modelling of error and bias in the WHO UIC iodine status methodology, with and without using predictor variables for mean urine volume across populations.