Bring a large pot of salted water to a boil. Add the pappardelle pasta and cook until al dente, about 8-10 minutes. Reserve 1/2 cup of pasta water, then drain.

Melt 2 tablespoons of salted butter in a medium saucepan over medium heat. Add the minced garlic and sauté for about 1 minute until fragrant.

Stir in the heavy cream, whole milk, grated Parmesan cheese, fresh sage leaves, ground nutmeg, salt, and pepper. Heat until slightly thickened, about 3-5 minutes.

Remove the sage leaves and stir in the canned pumpkin, heating through for another 3-4 minutes.

Combine the cooked pasta with the sauce, adding reserved pasta water as needed for desired consistency. Adjust seasoning with salt and pepper.

Serve garnished with extra grated Parmesan cheese and fresh sage leaves.