1. Combine the meatball mix
In a roomy bowl, fold together the ground chicken, pumpkin purée, breadcrumbs, egg, grated garlic, onion powder, salt, and pepper. Handle the mixture gently — stop as soon as everything is evenly incorporated.

2. Shape the meatballs
Moisten your hands and roll the mixture into balls about 1½ inches across (a small scoop works great). Arrange them on a plate or tray — you should have roughly 16.

3. Brown the meatballs
Warm the olive oil in a nonstick skillet over medium heat. Add the meatballs in a single layer (don’t overcrowd) and sear until each side is golden, about 2–3 minutes per side. Do this in batches if needed. They’ll finish cooking in the sauce.

4. Prepare the sage cream
In a small saucepan, melt the butter over medium heat. Add the grated garlic and the minced sage and cook just until fragrant, about 30 seconds. Pour in the heavy cream, season with salt and pepper, and add the optional pinch of nutmeg. Reduce the heat and let the sauce barely simmer for 3–4 minutes until it starts to thicken slightly.

5. Finish the meatballs in the sauce
Move the browned meatballs into the simmering sauce. Cover or partially cover and cook for another 5–7 minutes, until the meatballs are cooked through and the sauce clings to them.

6. Serve
Transfer meatballs to shallow bowls or a serving platter, spooning plenty of sauce over top. Garnish with a few extra chopped sage leaves and a crack of black pepper, if you like.