Electron microscopy is a recognized standard tool for nanomaterial characterization, and recommended by the European Food Safety Authority for the size measurement of nanomaterials in food. Despite this, little data have been published assessing the reliability of the method, especially for size measurement of nanomaterials characterized by a broad size distribution and/or added to food matrices. This study is a thorough investigation of the measurement uncertainty when applying electron microscopy for size measurement of engineered nanomaterials in foods. Our results show that the number of measured particles was only a minor source of measurement uncertainty for nanomaterials in food, compared to the combined influence of sampling, sample preparation prior to imaging and the image analysis. The main conclusion is that to improve the measurement reliability, care should be taken to consider replications and matrix removal prior to sample preparation.