Nanostructured metal oxides, such as zinc oxide (ZnO), are considered as excellent materials for the fabrication of highly sensitive and selective electrochemical sensors and biosensors due to their good properties, including a high specific surface area, high catalytic efficiency, strong adsorption ability, high isoelectric point (IEP, 9.5), wide band gap (3.2 eV), biocompatibility and high electron communication features. Thus, ZnO nanostructures are widely used to fabricate efficient electrochemical sensors and biosensors for the detection of various analytes. In this review, we have discussed the synthesis of ZnO nanostructures and the advances in various ZnO nanostructure-based electrochemical sensors and biosensors for medical diagnosis, pharmaceutical analysis, food safety, and environmental pollution monitoring.