Microplastics (MPs) have become ubiquitous pollutants in food and environmental systems, raising concerns about human exposure and potential health risks. This review summarises the occurrence of MPs in important dietary sources, including seafood, drinking water, beverages, fruits, vegetables and dairy products, as well as their occurrence and potential migration from food packaging materials, in addition to inhalation as a substantial non-dietary exposure pathway. Additionally, the biological fate of MPs following ingestion and inhalation is discussed, with a focus on their translocation, tissue accumulation and potential to cause endocrine disruption, oxidative stress, inflammation, gut microbiota dysbiosis, reproductive toxicity and neurotoxicity. Current techniques for MP detection and characterisation, including microscopic, spectroscopic and thermal methods, as well as emerging techniques such as surface-enhanced Raman spectroscopy (SERS), laser direct infrared imaging (LDIR), hyperspectral imaging and artificial intelligence-assisted analysis, are critically reviewed. Important analytical challenges, including contamination control, nanoplastic detection and the lack of standardized techniques, are also discussed. Despite mounting evidence of MP occurrence and biological effects, major challenges remain, including the absence of standardized analytical protocols, difficulties in identifying nanoplastics, contamination during analysis and limited evidence regarding the long-term effects on human health. This review contributes by integrating current evidence on MP occurrence in food systems, human exposure pathways, biological fate, health impacts and analytical approaches, while identifying key methodological and regulatory gaps and priorities for future research. To improve risk assessment and develop practical strategies to reduce MP exposure, further efforts towards standardised procedures, improved monitoring, realistic exposure assessment and long-term human studies are required.