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Low bias overall with strong objectivity and rigorous methodology (large, population-based cohort, predefined noninvasive fibrosis scores, ECG-based outcomes, and careful confounder adjustment), though generalizability is limited to MASLD and potential measurement bias from noninvasive fibrosis indices.
Lifelines prospective cohort in the Netherlands assesses MASLD, uses FIB-4 and APRI to measure fibrosis burden, and links higher fibrosis with incident ECG-detected arrhythmias, particularly AF.
Objective, evidence-first bias; cautious with unreported confounders.
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