Traditional fermented foods and beverages (TFFB) are an important dietary component consumed in large quantities worldwide. Currently, much attention has been focused on the health benefits of TFFB. Melanoidins, a class of bioactive substance produced in the final stage of the Maillard reaction, not only have a significant impact on sensory properties of TFFB but also contribute to the health effects. Melanoidins formed in the fermentation system with a long reaction time at low temperature could be different from those obtained from high-temperature, short-duration roasted systems due to the multiple formative stages and involvement of microorganisms and enzymes. In this paper, the current state of knowledge regarding the formation, distribution, extraction and purification, physicochemical properties, structure characteristics, and biological activities of TFFB melanoidins are comprehensively reviewed, with predominant focus on TFFB that are typically brown like douchi, miso, cheonggukjang, soy sauce, huangjiu (Chinese rice wine), beer, vinegar, and sweet wine.The current challenges and prospective recommendations for the research of melanoidins in fermented systems are also presented. In future, people should pay more attention to the basic research on TFFB melanoidins, especially purification methods and formation mechanisms, further substantiation of health properties of TFFB melanoidins in vivo, and development of specific melanoidins to fulfill technological, productive, or health needs of consumers.