**Background:** Cardiovascular diseases (CVD) and diabetes are leading causes of death globally, responsible for 19.5 million deaths annually according to WHO. In Romania, CVD and diabetes accounted for 56.4% of all deaths in 2019, placing Romania among the highest in Europe. Despite this, no national screening programs exist for prevention or early identification. Polyphenols—natural compounds found in fruits, vegetables, whole grains, cocoa, tea, and wine—have demonstrated antioxidant, anti-inflammatory, antithrombotic, lipid-lowering, and prebiotic effects that may reduce cardiometabolic risk (CMR). This study aimed to assess Romanian adults' knowledge, understanding, and awareness of CMR and polyphenol benefits, and how sociodemographic and clinical characteristics influence this knowledge.
**Methods:** An online Google Forms questionnaire (24 questions, both open- and closed-ended) was administered to 546 adult participants living in Romania between November and December 2022. The questionnaire had three parts: (1) demographic, clinical, and anthropometric characteristics; (2) health concern, medical consultation frequency, CMR awareness, risk factor identification, and self-assessed 10-year risk of CVD or diabetes; (3) food concern, dietary patterns, frequency of polyphenol-rich food consumption, knowledge of polyphenols and their health effects, and preferred information sources. Data were analyzed using Microsoft Excel with results expressed as mean ± SD at 95% confidence. One-way ANOVA with post hoc Tukey test and Chi-square tests were used; significance was set at p < 0.05.
**Key Results:** Most respondents were female (80.6%), from urban areas, and had higher education. Overall, 78% reported concern about their health to a great or very great extent, and 60% reported similar concern about nutrition. The highest health concern was among those aged 30–39 and over 50 (80.61% reporting scores 4–5), and among normal-weight and underweight respondents. Overweight and obese respondents showed significantly lower health concern (p < 0.05). For nutrition concern, the 40–49 age group stood out, with significant differences by age (p < 0.05) and education (p < 0.05); the most significant difference was by weight status (p < 0.001), with normal-weight subjects most concerned and obese respondents least. Routine medical tests in the last year were reported by 67.7%, and medical consultations by 64%, with moderate correlation (r = 0.55, p < 0.001). Regarding CMR, 64.8% declared familiarity with the term. The most recognized risk factors were overweight (89.2%), sedentarism (73.5%), smoking (73.2%), and high blood pressure (71.5%); only 57.7% recognized increased fasting blood glucose, and just 15.0% recognized intestinal dysbiosis. For CMR-related conditions, diabetes was selected by 65.7%, acute myocardial infarction by 44.9%, heart failure by 44.3%, and stroke by 37.2%. Self-assessed 10-year risk of CVD or diabetes was rated as high by 9%, moderate by 47%, and low by 44%. A strong negative correlation was found between number of risk factors and low-risk self-assessment (r = −0.801), but a weak correlation between stated risk factors and high-risk self-assessment (r = 0.027). Notably, 34.2% of overweight and obese individuals did not perceive themselves as overweight, rising to 48.4% among overweight individuals specifically. For polyphenol knowledge, only 35% reported good or very good knowledge of the term 'polyphenols'; 47.6% found it totally unknown or slightly familiar. After being asked about food sources, 45.6% did not know that the foods they consumed were polyphenol sources. The highest knowledge was among those with post-secondary (62%) and university education (56%) (p < 0.001). Regarding health benefits, 86% recognized the antioxidant effect, 57% glycemic control, 54% anti-inflammatory, 50% lipid-profile control, 26% prebiotic effect, and 25% improved endothelial function. For information sources, 69% identified doctors and 68% dietitians/nutritionists as responsible, while 44% cited school, 33% specialized sites, 28% social media, and 27% pharmacists. Most respondents (77.7%) preferred functional foods over supplements for polyphenol intake.
**Clinical Implications:** This first-of-its-kind study in Romania reveals a substantial disconnect between self-reported health concern and actual knowledge of CMR factors and polyphenol benefits. While most respondents expressed high health concern and recognized major risk factors like overweight and smoking, critical gaps remained—particularly regarding fasting blood glucose, intestinal dysbiosis, and accurate personal risk perception. The weak correlation (r = 0.027) between recognized risk factors and self-assessed high risk suggests that awareness does not translate into personal risk understanding. The very low recognition of polyphenols' prebiotic effect (26%) and endothelial function improvement (25%) indicates that even among health-conscious populations, knowledge of bioactive compounds is limited. Given Romania's high CVD and diabetes mortality, these findings support the urgent need for targeted educational strategies delivered primarily by doctors and dietitians, with school-based programs for children. The preference for functional foods over supplements (77.7%) suggests an opportunity for developing polyphenol-enriched food products. Limitations include the online format (potential selection bias toward more health-conscious, educated, urban respondents), female predominance (80.6%), and reliance on self-reported data.