This systematic review evaluates the relationship between the local food environment and diet, focusing on the methods used to assess exposure (GIS, survey, or store audit) and the five dimensions of "food access" (availability, accessibility, affordability, acceptability, accommodation). The review includes 38 studies, with GIS-based measures being the most common but less consistently associated with diet than other measures. Few studies examined affordability, accommodation, and acceptability. The review highlights the need for a more comprehensive understanding of food access, including non-geographic dimensions, and provides recommendations for future research. The review finds that measures of food availability generally show consistent positive associations with healthy diets, while measures of accessibility are less consistently related to dietary outcomes. Affordability is not well captured by GIS-based measures and is instead assessed through other methods, showing mixed results. Acceptability and accommodation are less studied, but some studies show significant relationships with dietary outcomes. Dietary outcomes were assessed using various methods, including validated food frequency questionnaires, brief instruments, and store audits. Fruit and vegetable intake was the most commonly studied outcome, with mixed results depending on the measurement method. Fast food consumption showed the weakest evidence of association with the food environment. The review also notes that studies outside the U.S., Australia, and New Zealand showed inconsistent evidence of an association between the food environment and dietary behavior. The review emphasizes the need for standardized measures of food access and the importance of considering both geographic and non-geographic factors in assessing the food environment. Recommendations include refining measures of food access, developing understudied measures, redefining accessibility, paying attention to stores and food, and combining methods for more accurate assessments. The review concludes that a comprehensive understanding of the food environment-diet relationship is essential for improving public health outcomes.This systematic review evaluates the relationship between the local food environment and diet, focusing on the methods used to assess exposure (GIS, survey, or store audit) and the five dimensions of "food access" (availability, accessibility, affordability, acceptability, accommodation). The review includes 38 studies, with GIS-based measures being the most common but less consistently associated with diet than other measures. Few studies examined affordability, accommodation, and acceptability. The review highlights the need for a more comprehensive understanding of food access, including non-geographic dimensions, and provides recommendations for future research. The review finds that measures of food availability generally show consistent positive associations with healthy diets, while measures of accessibility are less consistently related to dietary outcomes. Affordability is not well captured by GIS-based measures and is instead assessed through other methods, showing mixed results. Acceptability and accommodation are less studied, but some studies show significant relationships with dietary outcomes. Dietary outcomes were assessed using various methods, including validated food frequency questionnaires, brief instruments, and store audits. Fruit and vegetable intake was the most commonly studied outcome, with mixed results depending on the measurement method. Fast food consumption showed the weakest evidence of association with the food environment. The review also notes that studies outside the U.S., Australia, and New Zealand showed inconsistent evidence of an association between the food environment and dietary behavior. The review emphasizes the need for standardized measures of food access and the importance of considering both geographic and non-geographic factors in assessing the food environment. Recommendations include refining measures of food access, developing understudied measures, redefining accessibility, paying attention to stores and food, and combining methods for more accurate assessments. The review concludes that a comprehensive understanding of the food environment-diet relationship is essential for improving public health outcomes.