The health risk and burden of disease associated with dietary exposure to pesticide residues in foodstuffs in Iran were assessed. The pesticide residue levels in foodstuffs in the country were determined through systematic review and meta-analysis. The non-carcinogenic risk, carcinogenic risk, and attributable burden of disease were estimated in terms of hazard quotient (HQ), incremental lifetime cancer risk (ILCR), and disability-adjusted life year (DALY), respectively. The meta-analysis showed that 58% of pesticide-food pairs lacked Codex maximum residue levels (MRLs), 34% had pesticide levels below these limits, and 8% exceeded them. Based on the average HQs, two foodstuffs (onion and tangerine) and two pesticides (haloxyfop-R-methyl and cyhalothrin) exhibited unacceptable non-cancer risk (>
1.0). The average ILCR value of lindane was assessed to be at the unacceptable level (1.4 × 10