01 - Bring a large pot of salted water to a boil. Add pasta and cook until al dente following package directions. Drain thoroughly and set aside.
02 - In the same pot over medium heat, stir together pumpkin puree, heavy cream or coconut milk, vegetable broth or water, dried sage, and ground nutmeg. Warm until gently simmering, stirring occasionally.
03 - Add the cooked pasta to the warm sauce, tossing continuously until noodles are evenly coated and the sauce is creamy. Sprinkle in grated Parmesan cheese and stir until completely melted and incorporated.
04 - Divide among serving plates. Garnish with additional Parmesan or fresh sage leaves if desired. Serve immediately.