Cook the fettuccine according to the package directions and drain.
Meanwhile, heat the olive oil in a medium nonstick skillet over low heat until warm. Add the garlic and sage. Cook for 2 minutes or until the garlic is fragrant but not browned, stirring frequently.
Stir in the pumpkin, heavy cream, salt, pepper, and nutmeg. Bring to a simmer over medium heat, stirring constantly. Cook for 3 minutes or until slightly thickened, stirring frequently.
Stir in the cottage cheese and 1/2 cup of the Parmesan cheese; cook for 1 minute or until warm.
Toss the pasta with the sauce. Sprinkle with remaining 1/4 cup Parmesan cheese and toasted pumpkin seeds.