In Vietnam, agricultural practices such as fertilizer and pesticide use affect the landscape as well as the availability and safety of food. For instance, pesticides and fertilizer end up in surface water used for drinking water, crop irrigation, and in fish tanks. However, the link to actual food consumption and health is complex and information is lacking. This study considers potential water-related exposure to toxic hazards in northern Vietnam food systems, through the consumption of food commodities and of water. Water pollution is operationalized by considering the following two channels: i) pesticide and nutrient leaching to surface water (share of surface water) and ii) industrial runoff from facilities located in urban areas (share of urban areas). We explore how potential exposure to toxic hazard is related to food consumption choices. Using a sample of the Vietnam Household Living Standard Survey (VHLSS) for 2014, we estimate how shares of food consumption categories in total food consumption are affected by household and landscape characteristics, the latter also reflecting potential environmental pressures. In districts with higher shares of surface water, the share of fish consumption is higher and the share of meat consumption is lower. From an environmental and health perspective, households in water-rich areas thus may have a higher probability of being exposed to toxic chemicals due to higher fish consumption. In districts with higher shares of urban areas, the shares of meat and cereals in total food consumption value were lower, and the shares of fish and fruit and vegetables were higher. The results indicate that food consumption is affected by landscape characteristics that may also influence the level of exposure to water-related environmental pressures, and that this combined effect may potentially exacerbate food safety and health risks. The actual impact is more complex and should be analyzed with more sophisticated data and methods.