The cold chain is an essential component of the food production and distribution system. This chapter reviews the main stages and technologies used for the preservation of perishable food products along the supply chain, and the amount of food lost or wasted along these stages for the main families of products. The chapter highlights the need for better refrigeration of food along the last stages of the cold chain (retail and consumer handling) and for better management along the commercial portion of the cold chain in developed countries. It also reveals the lack of progress made in the reduction of food loss or waste over the last two decades despite technological improvements, the consequences facing remote or northern communities because of the poor performance of the cold chain, and the potential of better leveraging data and mathematical modeling to achieve quantifiable reduction of loss and waste.