In a large pot, bring about 4 quarts of salted water to a rolling boil. Carefully add the fettuccine and cook according to the package instructions until al dente, usually around 8-10 minutes. Before draining, reserve 1/2 cup of the pasta water. Drain the pasta and set aside, keeping it warm.
In a large skillet, heat the olive oil over medium heat. Once the oil is shimmering, add the finely chopped onion. Sauté for about 3-4 minutes, or until the onion becomes translucent. Add the minced garlic and cook for an additional minute, stirring frequently until fragrant but not browned.
Reduce the heat to low, then stir in the pumpkin puree and heavy cream. Mix until fully combined, then increase the heat slightly to bring the mixture to a gentle simmer. Add the chopped sage, freshly grated nutmeg, salt, and pepper. Allow the sauce to simmer for about 5 minutes, stirring occasionally to ensure it doesn’t stick to the pan.
Gently fold the cooked fettuccine into the skillet with the pumpkin sauce. Use tongs or a pasta fork to toss, ensuring the pasta is evenly coated. Gradually add the reserved pasta water, a little at a time, until you achieve your desired creamy consistency.
Stir in the grated Parmesan cheese, mixing until it melts seamlessly into the sauce, creating a rich and creamy texture. Taste and adjust the seasoning with additional salt and pepper as necessary.
Carefully plate the creamy pumpkin sage pasta into bowls or on a large serving platter. Garnish with fresh sage leaves and a sprinkle of extra Parmesan cheese for an elevated touch. Enjoy immediately for the best flavor and creaminess!
Notes
Serve immediately for the best flavor and creaminess.