In the US, fettuccine Alfredo comes with heaps of butter, heavy cream, garlic, cheese, and sometimes chicken or shrimp as add-ons.
However, the version that exists in Italy is a little different from what most are used to seeing at Italian-American restaurants.
Fettuccine Alfredo was made famous by chef Alfredo Di Lelio in the early 1900s. At the time, his recipe consisted of pasta, butter, and non-aged Parmesan.
When the recipe made its way to America, chefs had to make due with the ingredients they had available. Many added cream, creating the dish most Americans think of today.
To make a more authentic version of this dish, ditch the heavy cream, chicken, and garlic, and invest in good Parmesan, butter, and egg pasta.