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Nevertheless, the following limitations should be acknowledged. Our data were obtained from the CDSS of Ningbo, and some important confounding factors were not available, such as smoking, alcohol consumption, and physical activity, which limited our further analysis. Besides, BMI was employed as the measure of adiposity, which does not reflect the overall fat distribution. Studies reported that waist circumference or waist-to-height ratio (WHR) might provide additional information beyond BMI for both incidence and mortality risk among middle-aged adults [43, 44]. And the generalizability of our findings is limited to newly diagnosed T2D subjects in Ningbo. Last, we could not stratify age into groups according to the life course (young, middle age, and older adulthood).
In conclusion, compared to the general population of Ningbo, T2D subjects had higher incident risk of IS. Newly diagnosed T2D subjects with normal BMI had a higher risk of IS compared to those who were overweight and obese, and increased height was related to decreased IS risk.
While their role is limited, observer countries are able to build relationships with Alliance members and other observer countries through ongoing activities and programs related to trade, market access to Asian and other global markets, small and medium enterprises, science and technology, education and other trade promotional opportunities.17 Some analysts state that observers to the Alliance may benefit from gaining increased access to Asia Pacific trade links.18 Observer status may help countries better understand the issues being negotiated in the Alliance and could help a country ultimately decide if wants to join as a member. One of the goals in the case of Australia, for example, would be to diversify trade by going beyond supplying the energy and minerals that have dominated its trade with Asia. While that particular trade pattern has led to a substantial increase in Australia's gross domestic product, it has not resulted in higher productivity, which would be necessary to raise living standards.19 In the case of Spain, Spanish Prime Minister Mariano Rajoy stated that the alliance could be a gateway to the booming Asia-Pacific region. Other European leaders have made similar statements.20
Up until 2013, Pacific Alliance members had some of the fastest-growing economies in the region. In 2013, Peru had the highest percentage change in real GDP at 5.7%, compared to 2.9% for the entire Latin American region. In 2015, GDP growth was 0.0% for all of Latin America and less than 3% for each of the Pacific Alliance countries (see Table 1).35 The four Latin American countries account for 37% of Latin America's population, 35% of Latin America's nominal GDP, 46% of exports and 50% of total imports. Mexico, however, accounts for much of the economic strength of the group. It represents 57% of the Alliance's population, 61% of the GDP, and 70% of exports as shown in Table 1.