Fettuccine alfreo is a pasta dish made from fettuccine pasta tossed with Parmesan cheese, butter, and heavy cream. As the cheese melts, it thickens the liquids to form a smooth and rich coating on the pasta. Although it was named by an Italian restaurateur, at his restaurant Alfredo alla Scrofa in Rome, it is largely an American dish, essentially the same as the Italian dish, Fettuccine al burro e panna meaning fettuccine with butter and cream; in Italy, the name 'Alfredo' is rarely used and the sauce is never named or prepared separately from the dish. In American cuisine, it is often mixed with other ingredients such as parsley, garlic, shrimp and chicken.