**5. Conclusions**

A Mediterranean-like hypocaloric diet helped to decrease the body weight, and associated hyperglycemia/hyperlipidemia and blood pressure in class-I obese patients intervened with PENS. However, the addition of *Lactobacillus plantarum LP115*, *Bifidobacterium brevis B3*, and *Lactobacillus acidophilus LA14*) promoted a positive influence on anti-obesogenic gu<sup>t</sup> bacteria by increasing muconutritive (*Akkermansia muciniphila*) and immunomodulatory (*Bifidobacterium spp*) microbiota, and Bacteroidetes phylum (*Prevotella spp*). Consequently, the Firmicutes/Bacteroidetes ratio was further reduced, and these changes could be mediating, at least in part, the further improvement of the body weight and plasma A1C, triglycerides, and HDL-cholesterol. Therefore, a combined strategy of a hypocaloric diet, PENS and probiotics administration may promote summative e ffects against obesity and related comorbidities (i.e., cardiovascular diseases). Nevertheless, larger studies are needed to analyze the direct actions and interactions of these strategies on gu<sup>t</sup> microbiota.

**Supplementary Materials:** The following are available online at http://www.mdpi.com/1660-4601/17/19/7239/s1, Figure S1. Gut bacteria in control subjects. Fecal samples from one hundred age- and sex-matched non-obese, normoglycemic, and normolipidemic voluntaries without known cardiovascular, malignant and digestive diseases were analyzed to estimate the control ranges for each bacteria. NGC/g: number of gene copies per gram of feces.

**Author Contributions:** M.C.-Y. and T.H. processed and analyzed the fecal samples. M.G.-A. acquired and interpreted the microbiota data. A.M.H. and C.L. provided the probiotics and diet recommendations to patients. J.L.-C. performed the statistics analysis. O.L. and J.R.-T. designed the study and wrote the manuscript. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research did not receive any specific gran<sup>t</sup> from funding agencies in the public, commercial, or not-for-profit sectors. L.-C.J. is a predoctoral fellow of Universidad Autónoma Madrid (FPI contract).

**Acknowledgments:** Authors want to thank Bromatech for the provision of probiotics Adomelle ® and for dealing with the costs of microbiota analysis.

**Conflicts of Interest:** The authors declare no conflict of interest.
