Bring a large pot of salted water to a rolling boil. Add fettuccine pasta and cook until al dente, about 8-10 minutes. Reserve ½ cup of cooking water before draining.

Heat olive oil in a large skillet over medium heat. Sauté minced garlic for about 1 minute until fragrant but not browned.

Stir in pumpkin puree, mixing well with the sautéed garlic. Cook for 2-3 minutes until heated through.

Pour in heavy cream, stirring until well combined. Simmer on low heat for 3-5 minutes until thickened.

Gradually stir in grated Parmesan cheese, seasoning with salt, pepper, and nutmeg. Add chopped fresh sage and cook for 1-2 minutes.

Add drained fettuccine to the skillet and toss until well coated. Adjust the sauce's consistency with reserved pasta cooking water as needed.

Transfer pasta to serving plates and garnish with extra Parmesan, fresh pepper, and sage if desired. Serve and enjoy!