1. Bring a large pot of salted water to a rolling boil. Add your fettuccine or chosen pasta and cook according to package directions until al dente. Before draining, reserve about 1 cup of the starchy pasta water. Drain the pasta and set it aside.

2. While the pasta is cooking, melt the butter in a large skillet or Dutch oven over medium heat. Add the finely diced yellow onion and cook, stirring occasionally, until softened and translucent, about 3-5 minutes.

3. Stir in the minced garlic and dried sage. Cook for another minute until fragrant, being careful not to burn the garlic.

4. Pour in the pumpkin puree, heavy cream, and chicken or vegetable broth. Whisk everything together until smooth. Bring the mixture to a gentle simmer, then reduce the heat to low.

5. Add the grated Parmesan cheese, salt, pepper, and an optional pinch of nutmeg to the sauce. Stir continuously until the cheese is fully melted and the sauce is smooth and creamy. Taste and adjust seasonings as needed. If the sauce seems too thick, add a splash of the reserved pasta water until it reaches your desired consistency.

6. Add the drained pasta directly into the skillet with the pumpkin alfredo sauce. Toss gently to coat all the pasta evenly.

7. Divide the pasta among serving bowls. Garnish with extra grated Parmesan cheese and fresh chopped parsley, if desired. Enjoy your warm and cozy meal!