01 - Bring a large pot of salted water to a rolling boil. Cook fettuccine or spaghetti according to package directions until al dente. Reserve 1/2 cup of pasta cooking water before draining.
02 - While the pasta cooks, melt butter with olive oil in a large skillet over medium heat. Add the thinly sliced onions and sprinkle with sugar and salt.
03 - Cook onions, stirring frequently, for 25 to 30 minutes until golden brown and deeply caramelized. If onions begin to stick to the pan, add a splash of water to deglaze and continue cooking.
04 - Stir in the minced garlic and cook for 1 minute until fragrant.
05 - Reduce heat to low and pour in the heavy cream and milk, stirring to combine. Add Parmesan cheese, black pepper, and nutmeg if using. Simmer for 2 to 3 minutes until the sauce thickens slightly. Adjust salt to taste.
06 - Add the drained pasta to the skillet and toss well, adding reserved pasta water as needed to achieve a silky, creamy sauce that evenly coats the noodles.
07 - Serve immediately, garnished with chopped fresh parsley and extra grated Parmesan.