Cook fettuccine according to package instructions until al dente. Strain pasta, reserving 1 cup pasta water.
While pasta is cooking, melt butter in large skillet over medium high heat. Add cream and pumpkin puree and whisk until smooth.
Add parmesan cheese, salt, pepper and nutmeg and stir until combined. Simmer gently for a few minutes until slightly thickened.
Add drained pasta and toss in sauce. If sauce is too thick, add reserved pasta water a tablespoon at a time until smooth. Serve immediately, with optional toppings if desired.
To make toppings:
Add pine nuts to a small dry skillet and toast over medium low heat 2-3 minutes or until nuts are lightly golden brown, stirring often. Remove pine nuts from pan and set aside.
Melt butter in pan. Add sage leaves and fry 1-2 minutes until crispy, flipping halfway through. Transfer to a paper towel to drain.
Serve pasta topped with toasted pine nuts, sage leaves and additional parmesan cheese.
Calories: 782kcal, Carbohydrates: 68g, Protein: 20g, Fat: 49g, Saturated Fat: 26g, Cholesterol: 199mg, Sodium: 951mg, Potassium: 409mg, Fiber: 5g, Sugar: 4g, Vitamin A: 8616IU, Vitamin C: 2mg, Calcium: 237mg, Iron: 3mg