This study presents a systematic review of 53 peer-reviewed articles published between 1979 and 2024 to evaluate the impacts of floods and droughts on food security in Nepal. This review employs the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) framework to systematically evaluate the impact of hydroclimatic extremes on the four aspects of food security: availability, access, utilization, and stability, going beyond simple narrative synthesis. The review reveals increasing trends in the frequency and severity of both floods and droughts, with substantial impacts on agricultural productivity, market access, infrastructure, and rural livelihoods. Compound events, where floods and droughts co-occur or follow one another, further destabilize food systems. Descriptive analysis showed that most studies were concentrated in recent years, with a dominant focus on floods over droughts, and limited integration of both hazards with food security outcomes. The majority of studies (74%) employed quantitative methods, but few examined the combined socio-environmental drivers of food insecurity. The review identifies significant gaps in the current literature. It highlights the inadequate incorporation of socioeconomic variables within climate risk models, a deficiency in the availability of real-time and high-resolution data, the insufficient representation of marginalized populations, and the lack of longitudinal studies examining nutrition and health outcomes. A limited number of studies specifically focus on the various ways hydroclimatic extremes influence food security. This review offers new perspectives by thematically categorizing impacts based on food security dimensions and emphasizes the critical need for localized, integrated, and adaptable policy measures. The results provide a foundation for more thorough research and strategic planning aimed at improving resilience to climate-related food insecurity in Nepal.