Alfredo di Lelio, the owner of the restaurant Alfredo alla Scrofa in Rome, Italy, devised Fettuccine Alfredo in the early 20th century as a variation on the common Italian dish Fettuccine al burro e panna, meaning fettuccine with butter and cream.
Fettuccine Alfredo is served mostly in America, or, if served in Italy, mostly to American tourists.