Background People accessing food aid in high-income countries are often food insecure with a nutritionally inadequate diet. We aimed to systematically review and synthesise studies investigating the relationship between food aid interventions and food insecurity, diet quality and mental health in households with children under 18 years of age in high-income country settings.

Methods A search was conducted electronically in Web of Science, MEDLINE, CINAHL and PsycINFO. Articles published from 1st January 2008 reporting quantitative outcomes, including cross-sectional, cohort and intervention studies in high-income countries were eligible for inclusion. For the purpose of this review, food aid was defined as food banks or other interventions providing free food items by community and/or charitable organisations. This included mobile pantries, home delivery of food parcels and school backpack programmes. Studies where at least some participants were from households with at least one child ≤ 18 years of age were included. The National Heart Lung and Blood Institute Assessment Tool was used to evaluate risk of bias in the included studies.

Results The search identified 10,394 records, of which 3,414 were duplicates. Abstracts for 278 records were screened leaving 25 papers for full-text screening. Nine papers were included in this review from the USA and Canada. Outcomes assessed were highly heterogenous. A food parcel delivery randomised control trial was rated as good for the quality assessment. Four studies were rated as fair and three as poor due to factors such as convenience sampling and high attrition. Significant improvements in food security were reported by using food banks located in community resource centres providing additional integrated health and social support and with client choice-based models. Diet quality was significantly improved in a food parcel delivery intervention and observed in a cross-sectional study for participants accessing food aid. A non-significant increase of fruit and vegetables was also reported in a mobile pantry with free children’s lunch programme. Only one study observed greater odds of consuming foods with added sugar with higher frequency of food bank use. A small but significant improvement in mental health score was reported between baseline and the end of an 18-month cohort study.

Conclusion Diet quality was improved by accessing food aid in a few studies. Food insecurity generally remains persistent, with many households relying on food aid in the long term. Providing choice and further social support appears to have greater positive outcomes and should be integrated into current food aid interventions.