It is widely believed that spaghetti with meatballs was an innovation of early 20th-century Italian immigrants in New York City; the National Pasta Association (originally named the National Macaroni Manufacturers Association) is said to be the first organization to publish a recipe for it, in the 1920s. Italian writers often mock the dish as pseudo-Italian or non-Italian. However, pasta served with meatballs and tomato sauce are found in southern Italy and are documented earlier than the American version:
"...though Spaghetti with meatballs are rare in Italy there are Italian precursors: I have had spaghetti with tiny meatballs in Puglia, [Sicilian food authority] Pino Correnti notes that meatballs were a common addition to feast day pasta sauces in Sicily..."
Pasta of various kinds with meatballs are part of the culinary tradition of the Abruzzo, Apulia, Sicily, and other parts of southern Italy. Names for these dishes include pasta seduta 'seated pasta' and maccaroni azzese in Apulia.
Totally different are the baked pasta dishes from Apulia, where meatballs, mortadella, or salami are baked with rigatoni, tomato sauce, and mozzarella, then covered with a pastry top.
Other pasta recipes include slices of meat rolled up with cheese, cured meats and herbs (involtini in Italian), but most commonly pasta is garnished with the sauce and served separately from the meats cooked in the sauce itself.