In a large mixing bowl, combine ground chicken, pumpkin purée, breadcrumbs, egg, finely grated garlic, onion powder, salt, and black pepper. Mix gently until just combined.

Using your hands, scoop out about 1.5 tablespoons of the mixture and roll it into a meatball. Repeat until all mixture is formed into approximately 16 meatballs.

Heat olive oil in a nonstick skillet over medium heat and add meatballs. Cook for 2-3 minutes on each side, until golden brown and cooked through.

Melt butter in a separate saucepan over medium heat, then add minced garlic and chopped sage. Stir for 30 seconds until fragrant.

Slowly stir in heavy cream, season with salt, pepper, and nutmeg. Let it simmer for about 3-4 minutes until thickened.

Once meatballs are cooked, add them to the creamy sage sauce and simmer for an additional 5-7 minutes.

Plate the meatballs and drizzle with the creamy sage sauce. Garnish with extra chopped sage and black pepper.