Cook the pasta: Bring a large pot of salted water to a boil. Cook pasta until just shy of al dente. Reserve 1 cup of pasta water, then drain.

Mix the meatballs: In a bowl, combine ground meat, breadcrumbs, egg, 1/2 cup Parmesan, 2 minced garlic cloves, 2 tablespoons chopped parsley, 1 teaspoon salt, and 1/2 teaspoon pepper. Mix gently until just combined.

Form and brown: Roll into 1 to 1.5-inch balls. Heat olive oil in a large skillet over medium-high. Brown meatballs on all sides, 6–8 minutes total. Transfer to a plate. They’ll finish cooking in the sauce.

Start the Alfredo base: Lower heat to medium. Add butter to the same skillet. Stir in the remaining minced garlic and cook 30 seconds until fragrant. Scrape up the browned bits.

Build the sauce: Pour in the heavy cream. Simmer gently 2–3 minutes to thicken slightly. Stir in remaining 1/2 cup Parmesan. Add a pinch of nutmeg and black pepper. If too thick, loosen with a splash of broth or reserved pasta water.

Finish the meatballs: Add meatballs back to the skillet. Simmer 5–7 minutes, turning occasionally, until cooked through (internal temp 160°F for beef/pork, 165°F for poultry).

Toss with pasta: Add drained pasta to the skillet and toss to coat. Use reserved pasta water to create a glossy, creamy consistency that clings to the noodles.

Brighten and garnish: Add lemon zest and a small squeeze of juice if using. Sprinkle more parsley and extra Parmesan. Taste and adjust salt and pepper.

Serve hot: Plate immediately while the sauce is silky. A final drizzle of olive oil is a nice touch.