In a large pot of salted boiling water, cook fettuccine according to package directions until al dente. Drain.

In a large skillet, melt butter over medium heat. Add garlic and sauté until fragrant, about one minute. Stir in the sage. Add the pumpkin, heavy cream, nutmeg, salt and pepper and stir until incorporated. Add in the parmesan cheese and simmer until thickened, about five minutes.

Remove the sauce from the heat and toss in the pasta. Serve immediately with fresh sage and more Parmesan, if desired.