This systematic review evaluates the relationship between the local food environment and dietary outcomes, focusing on the method of exposure assessment (GIS, survey, or store audit). The study explores five dimensions of "food access" (availability, accessibility, affordability, accommodation, and acceptability) using a conceptual definition proposed by Penchansky and Thomas (1981). Thirty-eight studies were reviewed and categorized by the exposure assessment method and the conceptual dimensions of access they captured. GIS-based measures were the most common, but were less consistently associated with diet than other methods. Few studies examined affordability, accommodation, and acceptability. The review highlights the need for standardized and validated measures, the development of understudied measures, and the combination of multiple assessment techniques to improve the accuracy and comprehensiveness of the food environment-diet relationship. Recommendations for future research include standardizing and validating measures, developing understudied measures, revamping the notion of accessibility, combining methods, and continuously defining "food access."This systematic review evaluates the relationship between the local food environment and dietary outcomes, focusing on the method of exposure assessment (GIS, survey, or store audit). The study explores five dimensions of "food access" (availability, accessibility, affordability, accommodation, and acceptability) using a conceptual definition proposed by Penchansky and Thomas (1981). Thirty-eight studies were reviewed and categorized by the exposure assessment method and the conceptual dimensions of access they captured. GIS-based measures were the most common, but were less consistently associated with diet than other methods. Few studies examined affordability, accommodation, and acceptability. The review highlights the need for standardized and validated measures, the development of understudied measures, and the combination of multiple assessment techniques to improve the accuracy and comprehensiveness of the food environment-diet relationship. Recommendations for future research include standardizing and validating measures, developing understudied measures, revamping the notion of accessibility, combining methods, and continuously defining "food access."